Alternative donor transplantation for older patients with acute myeloid leukemia in first complete remission: A center for international blood and marrow transplant research-eurocord analysis

Daniel Weisdorf, Mary Eapen, Annalisa Ruggeri, Mei Jie Zhang, Xiaobo Zhong, Claudio Brunstein, Celalettin Ustun, Vanderson Rocha, Eliane Gluckman

Research output: Contribution to journalArticlepeer-review

64 Scopus citations

Abstract

We studied patients with acute myeloid leukemia (AML) over age 50 and in first complete remission (CR1) after adult unrelated donor (URD) (n = 441, 8/8 HLA matched; n = 94, 7/8 HLA matched) or umbilical cord blood (UCB; n = 205) transplantations. UCB recipients achieved CR1 within 8 weeks less often, and received reduced-intensity conditioning and cyclosporine-based graft-versus-host disease (GVHD) prophylaxis more often. Neutrophil recovery was slower in UCB (69% by day 28) compared with 8/8 HLA-matched URD (97%) and 7/8 HLA-matched (91%) (P < .001) recipients. Three-year transplantation-related mortality (TRM) was higher and leukemia-free survival (LFS) lower with UCB (35% and 28%, respectively) versus 8/8 HLA-matched URD (27% and 39%, respectively). TRM was higher in 7/8 HLA-matched URD (41%, P = .01), but LFS was similar at 34% (P = .39). Three-year chronic GVHD was the lowest in UCB (28%) versus 53% and 59% in 8/8 and 7/8 HLA-matched URD recipients, respectively. Three-year survival was 43% in 8/8 HLA-matched URD (95% confidence interval [CI], 38% to 48%), 30% in UCB (95% CI, 23% to 37%) (P = .002) and 37% in 7/8 URD (95% CI, 27 to 46). Allotransplantation for AML in CR1 with any of these grafts extends LFS for over one third of older patients. In the absence of an 8/8 HLA-matched URD or when transplantation is needed urgently, UCB can provide extended survival. Less frequent chronic GVHD with UCB transplantation may be of particular value for older patients.

Original languageEnglish (US)
Pages (from-to)816-822
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume20
Issue number6
DOIs
StatePublished - Jun 2014

Bibliographical note

Funding Information:
Financial disclosure: Supported in part by grants from the NIH and the National Institute for Health Research (NIHR) , Oxford Biomedical Research Centre at Oxford University Hospitals NHS Trust and University of Oxford .

Keywords

  • Acute myeloid leukemia
  • Allogeneic transplantation
  • Umbilical cord blood
  • Unrelated donors

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