Similar Overall survival using sibling, unrelated donor, and cord blood grafts after reduced-intensity conditioning for older patients with acute myelogenous leukemia

Régis Peffault de Latour, Claudio G. Brunstein, Raphael Porcher, Patrice Chevallier, Marie Robin, Erica Warlick, Alienor Xhaard, Celalettin Ustun, Jérôme Larghero, Nathalie Dhedin, Mohamad Mohty, Gerard Socié, Daniel Weisdorf

Research output: Contribution to journalArticlepeer-review

60 Scopus citations

Abstract

For older patients with acute myeloid leukemia (AML), allogeneic hematopoietic cell transplantation (HCT) provides the best chance of long-term survival. A formal comparison between matched sibling (SIB), unrelated donor (URD), or umbilical cord blood (UCB) transplantation has not yet been reported in this setting. We compared reduced-intensity conditioning HCT in 197 consecutive patients 50years and older with AML in complete remission from SIB (n=82), URD (n=35), or UCB (n=80) transplantation. The 3-year cumulative incidences of transplantation-related mortality were 18%, 14%, and 24% with SIB, URD, and UCB transplantation, respectively (. P=.22). The 3-year leukemia-free survival rates were 48%, 57%, and 33% with SIB, URD, and UCB transplantation, respectively (. P=.009). In multivariate analysis, poor-risk cytogenetics was associated with relapse (hazard ratio, 1.7 [95% confidence interval, 1.0 to 3.0]; P=.04) and worse leukemia-free survival (hazard ratio, 1.6 [95% confidence interval, 1.0 to 2.5]; P=.03), whereas donor choice had no significant impact on overall survival (. P=.73). Adjusted 3-year overall survival rates were 55% with SIB, 45% with URD, and 43% with UCB transplantation (. P=.26). Until prospective studies are completed, this study supports the recommendation to consider SIB donor, URD, or UCB for HCT for older patients with AML in complete remission.

Original languageEnglish (US)
Pages (from-to)1355-1360
Number of pages6
JournalBiology of Blood and Marrow Transplantation
Volume19
Issue number9
DOIs
StatePublished - Sep 2013

Keywords

  • Acute myeloid leukemia
  • Cord blood
  • Older patients
  • Reduced-intensity conditioning regimen
  • Unrelated donor

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