Summary:
This is a retrospective comparison of partially mismatched related donor transplantation (PMRDT) and autotransplantation (ABMT) in advanced acute leukemia. Patients underwent T-cell-depleted PMRDT (n=164) or ABMT (n=131) for acute myeloid leukemia (n=130) or acute lymphoblastic leukemia (n=165). Fewer PMRDT patients were in remission (29 vs 85%; P<0.0001). The 5-year cumulative incidence of transplant-related mortality (TRM) was 52% after PMRDT and 16% after ABMT (P<0.0001). The 5-year cumulative incidence of relapse was 32% after PMRDT and 54% after ABMT (P=0.006). The actuarial unadjusted 5-year disease-free survival (DFS) was 16% after PMRDT and 30% after ABMT. In Cox's regression analysis, PMRDT (P<0.0001) and age >15 years (P=0.002) were associated with higher TRM, active disease (P=0.0021), ABMT (P=0.0074) and male sex (P=0.011) with higher relapse, and age >15 years (P=0.0007) and PMRDT (P=0.047) with lower DFS. Amongst second remission patients, TRM was higher after PMRDT (P=0.0003), relapse was higher after ABMT (P=0.034), and 5-year DFS was comparable (32% ABMT and 25% PMRDT). ABMT, if feasible, may be preferable to PMRDT in advanced acute leukemia patients since lower relapse after PMRDT is offset by higher TRM. If an autograft is not feasible because of nonavailability of autologous cells or very advanced disease, PMRDT is a potential alternative.
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References
Mehta J, Powles RL . Autologous blood and marrow transplantation. In: Whittaker JA, Holmes JA (eds). Leukaemia and Associated Diseases. Blackwell Science: Oxford, 1998, pp 455–481.
Chopra R, Goldstone AH, McMillan AK et al. Successful treatment of acute myeloid leukemia beyond first remission with autologous bone marrow transplantation using busulfan/cyclophosphamide and unpurged marrow: the British autograft group experience. J Clin Oncol 1991; 9: 1840–1847.
Petersen FB, Lynch MHE, Clift RA et al. Autologous marrow transplantation for patients with acute myeloid leukemia in untreated first relapse or in second complete remission. J Clin Oncol 1993; 11: 1353–1360.
Mehta J, Powles R, Singhal S et al. Melphalan–total body irradiation and autologous bone marrow transplantation for adult acute leukemia beyond first remission. Bone Marrow Transplant 1996; 18: 119–123.
Powles RL, Morgenstern GR, Kay HE et al. Mismatched family donors for bone-marrow transplantation as treatment for acute leukaemia. Lancet 1983; 1: 612–615.
Anasetti C, Amos D, Beatty PG et al. Effect of HLA compatibility on engraftment of bone marrow transplants in patients with leukemia or lymphoma. N Engl J Med 1989; 320: 197–204.
Kernan NA, Bartsch G, Ash RC et al. Analysis of 462 transplantations from unrelated donors facilitated by the National Marrow Donor Program. N Engl J Med 1993; 328: 593–602.
Gluckman E, Rocha V, Boyer-Chammard A et al. Outcome of cord-blood transplantation from related and unrelated donors. Eurocord Transplant Group and the European Blood and Marrow Transplantation Group. N Engl J Med 1997; 337: 373–381.
Henslee-Downey PJ, Abhyankar SH, Parrish RS et al. Use of partially mismatched related donors extends access to allogeneic marrow transplant. Blood 1997; 89: 3864–3872.
Mehta J, Singhal S, Chiang KY et al. Haploidentical BMT for acute leukemia: single-center experience of 220 patients. Blood 2000; 96(Suppl. 1): 840a.
Mehta J, Tricot G, Jagannath S et al. Salvage autologous or allogeneic transplantation for multiple myeloma refractory to or relapsing after a first-line autograft? Bone Marrow Transplant 1998; 21: 887–892.
Mehta J . Graft-versus-leukemia reactions in clinical bone marrow transplantation. Leu Lymphoma 1993; 10: 427–432.
Busca A, Anasetti C, Anderson G et al. Unrelated donor or autologous marrow transplantation for treatment of acute leukemia. Blood 1994; 83: 3077–3084.
Weisdorf D, Bishop M, Dharan B et al. Autologous vs allogeneic unrelated donor transplantation for acute lymphoblastic leukemia: comparative toxicity and outcomes. Biol Blood Marrow Transplant 2002; 8: 213–220.
Lazarus HM, Perez WS, Weisdorf D et al. Autologous vs unrelated donor (URD) transplantation for acute myeloid leukemia (AML) in first or second remission (CR1 or CR2). Blood 2000; 96 (Suppl. 1): Abstract #1781.
Soiffer RJ, Mauch P, Tarbell NJ et al. Total lymphoid irradiation to prevent graft rejection in recipients of HLA non-identical T cell-depleted allogeneic marrow. Bone Marrow Transplant 1991; 7: 23–33.
Henslee-Downey PJ . Mismatched bone marrow transplantation. Curr Opin Oncol 1995; 7: 115–121.
Henslee-Downey PJ, Parrish RS, MacDonald JS et al. Combined in vitro and in vivo T lymphocyte depletion for the control of graft-versus-host disease following haploidentical marrow transplant. Transplantation 1996; 61: 738–745.
Aversa F, Tabilio A, Velardi A et al. Treatment of high-risk acute leukemia with T-cell-depleted stem cells from related donors with one fully mismatched HLA haplotype. N Engl J Med 1998; 339: 1186–1193.
Handgretinger R, Schumm M, Lang P et al. Transplantation of megadoses of purified haploidentical stem cells. Ann NY Acad Sci 1999; 872: 351–361.
Godder KT, Mehta J, Chiang KY et al. Partially mismatched related donor bone marrow transplantation as salvage for patients with AML who failed autologous stem cell transplant. Bone Marrow Transplant 2001; 28: 1031–1036.
Chiang KY, van Rhee F, Godder K et al. Allogeneic bone marrow transplantation from partially mismatched related donors as therapy for primary induction failure acute myeloid leukemia. Bone Marrow Transplant 2001; 27: 507–510.
Singhal S, Powles R, Henslee-Downey PJ et al. Allogeneic transplantation from HLA-matched sibling or partially HLA-mismatched related donors for primary refractory acute leukemia. Bone Marrow Transplant 2002; 29: 291–295.
Mehta J, Powles R, Treleaven J et al. Outcome of acute leukemia relapsing after bone marrow transplantation: utility of second transplants and adoptive immunotherapy. Bone Marrow Transplant 1997; 19: 709–719.
Mehta J, Powles R, Treleaven J et al. Autologous transplantation with CD52 monoclonal antibody-purged marrow for acute lymphoblastic leukemia: long-term follow-up. Leu Lymphoma 1997; 25: 479–486.
Gooley TA, Leisenring W, Crowley J, Storer BE . Estimation of failure probabilities in the presence of competing risks: new representations of old estimators. Stat Med 1999; 18: 695–706.
Klein JP, Rizzo JD, Zhang MJ, Keiding N . Statistical methods for the analysis and presentation of the results of bone marrow transplants. Part I: unadjusted analysis. Bone Marrow Transplant 2001; 28: 909–915.
Chakraverty R, Peggs K, Chopra R et al. Limiting transplantation-related mortality following unrelated donor stem cell transplantation by using a nonmyeloablative conditioning regimen. Blood 2002; 99: 1071–1078.
Drobyski WR, Klein J, Flomenberg N et al. Superior survival associated with transplantation of matched unrelated vs one-antigen-mismatched unrelated or highly human leukocyte antigen-disparate haploidentical family donor marrow grafts for the treatment of hematologic malignancies: establishing a treatment algorithm for recipients of alternative donor grafts. Blood 2002; 99: 806–814.
Petersdorf EW, Gooley TA, Anasetti C et al. Optimizing outcome after unrelated marrow transplantation by comprehensive matching of HLA class I and II alleles in the donor and recipient. Blood 1998; 92: 3515–3520.
Hansen JA, Gooley TA, Martin PJ et al. Bone marrow transplants from unrelated donors for patients with chronic myeloid leukemia. N Engl J Med 1998; 338: 962–968.
Mehta J, Powles R, Singhal S et al. Autologous bone marrow transplantation for acute myeloid leukemia in first remission: identification of modifiable prognostic factors. Bone Marrow Transplant 1995; 16: 499–506.
Powles R, Sirohi B, Treleaven J et al. The role of post-transplant maintenance chemotherapy in improving the outcome of autotransplantation in adult acute lymphoblastic leukemia. Blood 2002; 100: 1641–1647.
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Singhal, S., Henslee-Downey, P., Powles, R. et al. Haploidentical vs autologous hematopoietic stem cell transplantation in patients with acute leukemia beyond first remission. Bone Marrow Transplant 31, 889–895 (2003). https://doi.org/10.1038/sj.bmt.1704031
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DOI: https://doi.org/10.1038/sj.bmt.1704031
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