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Acute Leukemias

Comparison of matched unrelated and matched related donor myeloablative hematopoietic cell transplantation for adults with acute myeloid leukemia in first remission

Leukemia volume 24, pages 1276–1282 (2010)Cite this article

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Abstract

Hematopoietic cell transplantation (HCT) from a matched related donor (MRD) benefits many adults with acute myeloid leukemia (AML) in first complete remission (CR1). The majority of patients does not have such a donor and will require an alternative donor if HCT is to be undertaken. We retrospectively analyzed 226 adult AML CR1 patients undergoing myeloablative unrelated donor (URD) (10/10 match, n=62; 9/10, n=29) or MRD (n=135) HCT from 1996 to 2007. The 5-year estimates of overall survival, relapse and nonrelapse mortality (NRM) were 57.9, 29.7 and 16.0%, respectively. Failure for each of these outcomes was slightly higher for 10/10 URD than MRD HCT, although statistical significance was not reached for any end point. The adjusted hazard ratios (HRs) were 1.43 (0.89–2.30, P=0.14) for overall mortality, 1.17 (0.66–2.08, P=0.60) for relapse and 1.79 (0.86–3.74, P=0.12) for NRM, respectively, and the adjusted odds ratio for grades 2–4 acute graft-versus-host disease was 1.50 (0.70–3.24, P=0.30). Overall mortality among 9/10 and 10/10 URD recipients was similar (adjusted HR 1.16 (0.52–2.61), P=0.71). These data indicate that URD HCT can provide long-term survival for CR1 AML; outcomes for 10/10 URD HCT, and possibly 9/10 URD HCT, suggest that this modality should be considered in the absence of a suitable MRD.

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Acknowledgements

We acknowledge the excellent care provided to the patients by the physicians and nurses of the HCT teams, as well as the work of the staff in the Long Term Follow-up office at the Fred Hutchinson Cancer Research Center. We are greatly indebted to Lacey M Hedin and Amanda M Axtman for their help with data collection. This work was supported by NIH Grants P01-CA18029, P01-AI33484, K08-CA95448, K23-CA137161, and K99-HL088021, and the Frederick Kullman Memorial Fund. JMP is supported by Career Development Awards from the Lymphoma Research Foundation and is a clinical scholar of the Damon Runyon Cancer Foundation.

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Author notes

  1. R B Walter and J M Pagel: These authors contributed equally to this work.

Authors and Affiliations

  1. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    R B Walter, J M Pagel, T A Gooley, E W Petersdorf, M L Sorror, A E Woolfrey, J A Hansen, A I Salter, E Lansverk, F M Stewart, P V O'Donnell & F R Appelbaum

  2. Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, USA

    R B Walter

  3. Department of Medicine, Division of Medical Oncology, University of Washington, Seattle, WA, USA

    J M Pagel, E W Petersdorf, J A Hansen, F M Stewart, P V O'Donnell & F R Appelbaum

  4. Department of Pediatrics, University of Washington, Seattle, WA, USA

    A E Woolfrey

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  1. R B Walter
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Correspondence to R B Walter.

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The authors declare no conflict of interest.

Additional information

This work was presented in part at the 2007 Annual Meetings of the American Society of Clinical Oncology (ASCO; abstract #7000) and the American Society of Hematology (ASH; abstract #330).

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Walter, R., Pagel, J., Gooley, T. et al. Comparison of matched unrelated and matched related donor myeloablative hematopoietic cell transplantation for adults with acute myeloid leukemia in first remission. Leukemia 24, 1276–1282 (2010). https://doi.org/10.1038/leu.2010.102

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