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Allografting

The role of HLA-matched unrelated transplantation in adult patients with Ph chromosome-negative ALL in first remission. A decision analysis

Bone Marrow Transplantation volume 48, pages 1077–1083 (2013)Cite this article

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Abstract

The efficacy of unrelated transplantation for patients with ALL who lack an HLA-matched sibling remains unclear. We performed a decision analysis to determine the efficacy of myeloablative transplantation from a genetically HLA-A, -B, -DRB1 allele-matched unrelated donor for patients with Ph chromosome-negative ALL aged 21–54 years. The transition probabilities were estimated from the Japan Adult Leukemia Study Group studies (ALL93; n=80, ALL97; n=82), and the Japan Marrow Donor Program database (transplantation in first CR (CR1): n=177). The primary outcome measure was the 10-year survival probability with or without quality of life (QOL) adjustment. Subgroup analyses were performed according to risk stratification based on the WBC count and cytogenetics, and according to age stratification. In all patients, unrelated transplantation in CR1 was shown to be superior in analyses both with and without QOL adjustment (40.8 vs 28.4% and 43.9 vs 29.0%, respectively). A similar tendency was observed in all subgroups. The decision model was sensitive to the probability of leukemia-free survival following chemotherapy and the probability of survival after transplantation in standard-risk and higher-aged patients. Unrelated transplantation in CR1 improves the long-term survival probability in patients who lack an HLA-matched sibling. However, recent improvements in treatment strategies may change this result.

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Acknowledgements

We thank all the staffs of the JALSG centers and the JMDP centers providing excellent patient care and reporting clinical data.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan

    S Kako & Y Kanda

  2. Department of Biostatistics and Epidemiology, Yokohama City University, Kanagawa, Japan

    S Morita

  3. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    H Sakamaki

  4. Department of Hematology, Meitetsu Hospital, Aichi, Japan

    H Iida

  5. Department of Hematology and Oncology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    M Kurokawa

  6. Department of Hematology, Japanese Red Cross Nagoya First Hospital, Aichi, Japan

    K Miyamura

  7. Department of Hematology, Kanagawa Cancer Center, Kanagawa, Japan

    H Kanamori

  8. Division of Hematology, Ehime Prefectural Central Hospital, Ehime, Japan

    M Hara

  9. Department of Hematology, Sapporo Hokuyu Hospital, Hokkaido, Japan

    N Kobayashi

  10. Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Aichi, Japan

    Y Morishima

  11. Department of Pediatrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan

    K Kawa

  12. Department of Internal Medicine, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan

    T Kyo

  13. Department of Hematology, Saiseikai Maebashi Hospital, Gunma, Japan

    T Sakura

  14. Department of Hematology, Saitama Medical University, Saitama, Japan

    I Jinnai

  15. Department of Hematology and Rheumatology, Division of Medicine, Nihon University School of Medicine, Tokyo, Japan

    J Takeuchi

  16. Department of Hematology and Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

    Y Miyazaki

  17. Department of Hematology, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan

    S Miyawaki

  18. Oncology Center, Hamamatsu University School of Medicine, Shizuoka, Japan

    K Ohnishi

  19. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Aichi, Japan

    T Naoe

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  1. S Kako
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Correspondence to Y Kanda.

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Kako, S., Morita, S., Sakamaki, H. et al. The role of HLA-matched unrelated transplantation in adult patients with Ph chromosome-negative ALL in first remission. A decision analysis. Bone Marrow Transplant 48, 1077–1083 (2013). https://doi.org/10.1038/bmt.2013.4

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