Unrelated donor versus matched sibling donor in adults with acute myeloid leukemia in first relapse: an ALWP-EBMT studyReportar como inadecuado




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1 Service d-hématologie clinique et de thérapie cellulaire CHU Saint-Antoine 2 Università degli studi di Napoli Federico II 3 TUD - Technische Universität Dresden 4 University Hospital Essen 5 LMU - Ludwig-Maximilians University Munich 6 MHH - Hannover Medical School Hannover 7 Helios-Klinikum Berlin-Buch 8 Asklepios Klinik St. Georg Hamburg 9 University Medical Centre Freiburg 10 Hematology Laboratory, Hospices Civils de Lyon 11 University of Münster 12 Charles University Hospital 13 Charite-Universitatsmedizin Berlin Berlin 14 UKE - Universitaetsklinikum Hamburg-Eppendorf Hamburg 15 CR Saint-Antoine - Centre de Recherche Saint-Antoine 16 UPMC - Université Pierre et Marie Curie - Paris 6 17 Chaim Sheba Medical Center 18 ALWP-EBMT & Département d-hématologie et de thérapie cellulaire AP-HP Hôpital Saint-Antoine

Abstract : Background: Allogeneic stem cell transplantation is the only curative option for patients with acute myeloid leukemia AML experiencing relapse. Either matched sibling donor MSD or unrelated donor UD is indicated.Methods: We analyzed 1554 adults with AML transplanted from MSD n = 961 or UD n = 593, HLA-matched 10-10, n = 481; 9-10, n = 112. Compared to MSD, UD recipients were older 49 vs 52 years, p = 0.001, transplanted more recently 2009 vs 2006, p = 0.001, and with a longer interval to transplant 10 vs 9 months, p = 0.001. Conditioning regimen was more frequently myeloablative for patients transplanted with a MSD 61 vs 46 %, p = 0.001. Median follow-up was 28 range 3–157 months.Results: Cumulative incidence CI of neutrophil engraftment p = 0.07, grades II–IV acute GVHD p = 0.11, chronic GVHD p = 0.9, and non-relapse mortality NRM, p = 0.24 was not different according to the type of donor. At 2 years, CI of relapse relapse incidence RI was 57 vs 49 % p = 0.001. Leukemia-free survival LFS at 2 years was 21 vs 26 % p = 0.001, and overall survival OS was 26 vs 33 % p = 0.004 for MSD vs UD, respectively. Chronic GVHD as time-dependent variable was associated with lower RI HR 0.78, p = 0.05, higher NRM HR 1.71, p = 0.001, and higher OS HR 0.69, p = 0.001. According to HLA match, RI was 57 vs 50 vs 45 %, p = 0.001 NRM was 23 vs 23 vs 29 % p = 0.26, and LFS at 2 years was 21 vs 27 vs 25 % p = 0.003 for MSD, 10-10, and 9-10 UD, respectively. In multivariate analysis adjusted for differences between the two groups, UD was associated with lower RI HR 0.76, p = 0.001 and higher LFS HR 0.83, p = 0.001 compared to MSD. Interval between diagnosis and transplant was the other factor associated with better outcomes RI HR 0.62, p 



Autor: Annalisa Ruggeri - Giorgia Battipaglia - Myriam Labopin - Gerhard Ehninger - Dietrich Beelen - Johanna Tischer - Arnold Ganser -

Fuente: https://hal.archives-ouvertes.fr/



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