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Role of alternative donor allogeneic hematopoietic stem cell transplantation in patients with intermediate- or poor-risk acute myeloid leukemia in first complete remission

Bone Marrow Transplantation volume 54, pages 2004–2012 (2019)Cite this article

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Abstract

Allogeneic hematopoietic stem cell transplantation (HCT) offers the most effective prevention of relapse and has significant overall survival (OS) benefits for patients with acute myeloid leukemia (AML) in first complete remission (CR1). We conducted a retrospective analysis of a cohort of patients with intermediate- or poor-risk AML. The purpose of the present study was to investigate the role of alternative donors for AML in CR1. We analyzed 1561 patients who underwent HCT from an HLA-matched related donor (MRD), HLA 8/8-matched unrelated donor (MUD), or umbilical cord blood (UCB). The results of a multivariate analysis showed that HCT from UCB (HR = 1.28, 95% CI: 1.07–1.52), age ≥50 years (HR = 1.36, 95% CI: 1.14–1.62), male (HR = 1.42, 95% CI: 1.21–1.66), PS > 1 (HR = 1.68, 95% CI: 1.17–2.42), and poor-risk cytogenetics (HR = 1.53, 95% CI: 1.29–1.81) had an inferior prognostic impact on OS. We conclude that an MUD is the best alternative to an HLA identical MRD for patients with AML in CR1. UCB is an alternative option if neither MRD nor MUD are available, or when patients need to receive urgent HCT for poor-risk AML in CR1.

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Acknowledgements

We thank all the staff at the participating hospitals and centers at the JSHCT for their valuable contributions to this study.

Funding

This work was supported in part by the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from the Japan Agency for Medical Research and Development, AMED under Grant Number 18ek0510023h0002.

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Authors and Affiliations

  1. Division of Clinical Oncology and Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan

    Shingo Yano & Hiroki Yokoyama

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

    Masamitsu Yanada

  3. Division of Hematology, Jyoban Hospital Tokiwa Foundation, Fukushima, Japan

    Jinichi Mori

  4. Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan

    Jun Aoki

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

    Kazuteru Ohashi

  6. Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan

    Heiwa Kanomori

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

    Yuichiro Ozawa

  8. Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan

    Masashi Sawa

  9. Department of Hematology, Osaka City University Hospital, Osaka, Japan

    Hiroshisa Nakamae

  10. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    Tetsuya Eto

  11. Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan

    Shuichi Ohta

  12. Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan

    Junji Tanaka

  13. Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Tatsuo Ichinohe

  14. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Yoshiko Atsuta

  15. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yoshiko Atsuta

  16. Division of Hematology, Department of Internal Medicine, School of Medicine, Aichi Medical University, Nagakute, Japan

    Akiyoshi Takami

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  1. Shingo Yano
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Correspondence to Shingo Yano.

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Yano, S., Yokoyama, H., Yanada, M. et al. Role of alternative donor allogeneic hematopoietic stem cell transplantation in patients with intermediate- or poor-risk acute myeloid leukemia in first complete remission. Bone Marrow Transplant 54, 2004–2012 (2019). https://doi.org/10.1038/s41409-019-0571-8

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