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Acute Leukaemia

Haploidentical vs autologous hematopoietic stem cell transplantation in patients with acute leukemia beyond first remission

Bone Marrow Transplantation volume 31, pages 889–895 (2003)Cite this article

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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Authors and Affiliations

  1. Royal Marsden Hospital, Surrey, UK

    S Singhal, R Powles, J Treleaven, S Kulkarni, B Sirohi, C R Pinkerton, S Meller & J Mehta

  2. Division of Transplantation Medicine, University of South Carolina, South Carolina Cancer Center, Columbia, SC, USA

    S Singhal, P J Henslee-Downey, K Y Chiang, K Godder, F van Rhee & J Mehta

  3. The Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    S Singhal, B Jovanovic & J Mehta

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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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