Abstract
This report used the framework of a large European study to investigate the outcome of patients with and without an HLA-identical sibling donor on an intention-to-treat basis. After a common remission-induction and consolidation course, patients with an HLA-identical sibling donor were scheduled for allogeneic transplantation and patients lacking a donor for autologous transplantation. In all, 159 patients alive at 8 weeks from the start of treatment were included in the present analysis. In total, 52 patients had a donor, 65 patients did not have a donor and in 42 patients the availability of a donor was not assessed. Out of 52 patients, 36 (69%) with a donor underwent allogeneic transplantation (28 in CR1). Out of 65 patients, 33 (49%) received an autograft (27 in CR1). The actuarial survival rates at 4 years were 33.3% (s.e. = 6.7%) for patients with a donor and 39.0% (s.e. = 6.5%) for patients without a donor (P = 0.18). Event-free survival rates were 23.1% (s.e. = 6.2%) and 21.5% (s.e. = 5.3%), respectively (P = 0.66). Correction for alternative donor transplants did not substantially alter the survival of the group without a donor. Also, the survival in the various cytogenetic risk groups was not significantly different when comparing the donor vs the no-donor group. This analysis shows that patients with high-risk myelodysplastic syndrome and secondary acute myeloid leukemia may benefit from both allogeneic and autologous transplantation. We were unable to demonstrate a survival advantage for patients with a donor compared to patients without a donor.
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Acknowledgements
The work was supported in part by a grant of the National Cancer Institute (Grant nos 2U10-CA11488-22 to 2U10-CA11488-31). Its contents are solely the responsibility of the authors and do not represent the official views of the National Cancer Institute. We acknowledge Saint Jude Children's Research Hospital for providing a SAS macro allowing the analyses of competing risks.
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University Medical Centre Nijmegen, Nijmegen (T de Witte); Brussels U.Z. Gasthuisberg, Leuven (G Verhoef); University Hospital Rebro, Zagreb (B Labar); Hôpital Edouard Herriot, Lyon (A Belhabri); Leijenburg Ziekenhuis, The Hague (P Wijermans); Universitaetsklinikum Essen, Essen (V Runde); St Jan's Hospital, Brugge (D Selleslag); Leiden University Medical Centre (R Willemze); Kantonsspital Basel, Basel (A Gratwohl); Universita La Sapienza, Roma (F Mandelli); Cliniques Universitaires St Luc, Brussels (A Ferrant); Hôpital Dieu, Paris (R Zittoun); Klinikum Grosshadern Ludwig-Maximilians University, Munich (U Jehn); Universitair Ziekenhuis Antwerpen, Antwerpen (Z Berneman); Hopital Universitaire Erasme, Brussels (W Feremans); Inselspital, Bern (M Fey); Ospedale San Eugenio, Roma (S Amadori); Academisch Medisch Centrum, Amsterdam (J van der Lelie); Institut J Bordet, Brussels (P Strijckmans); Cliniques Universitaires de Mont Godinne, Yvoir (A Bosly); Centre Antoine Lacassagne, Nice (A Thyss); Onze Lieve Vrouwen gasthuis, Amsterdam (KJ Roozendaal); Atrium Medisch Centrum, Heerlen (M Fickers); Hospital de la Santa Creu I Sant Pau (Barcelona); Academisch Ziekenhuis Maastricht (H Schouten); Klinikum Nurnberg, Nurnberg (H Wandt); Innsbruck Universitaetsklinikum, Innsbruck (H Zwierzina); Jeroen Bosch Ziekenhuis, ‘s Hertogenbosch (H Sinnege); St Josef Ziekenhuis, Veldhoven (G Vreugdenhil); Algemeen Ziekenhuis Middelheim, Antwerpen (R de Bock); CHU Sart-Tilman, Liège (G Fillet); Kantonsspital Sankt Gallen, Sankt Gallen (U Hess); Heinrich Heine University, Dusseldorf (C Aul); Ospedale San Giovanni, Bellinzona (F Cavelli); Institute of Hematology and Blood Transfusion, Prague (J Cermak); Instituto Portugues de Oncologia-Centro de Coimbra, Coimbra (I Sousa).
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Oosterveld, M., Suciu, S., Verhoef, G. et al. The presence of an HLA-identical sibling donor has no impact on outcome of patients with high-risk MDS or secondary AML (sAML) treated with intensive chemotherapy followed by transplantation: results of a prospective study of the EORTC, EBMT, SAKK and GIMEMA Leukemia Groups (EORTC study 06921). Leukemia 17, 859–868 (2003). https://doi.org/10.1038/sj.leu.2402897
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DOI: https://doi.org/10.1038/sj.leu.2402897
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