Time to unrelated donor leukocyte infusion is longer, but incidence of GVHD and overall survival are similar for recipients of unrelated DLI compared to matched sibling DLI

2016 ◽  
Vol 91 (4) ◽  
pp. 426-429 ◽  
Author(s):  
Anita J. Kumar ◽  
Pavel Vassilev ◽  
Alison W. Loren ◽  
Selina M. Luger ◽  
Ran Reshef ◽  
...  
Keyword(s):  
Overall Survival ◽  
Unrelated Donor ◽  
Donor Leukocyte Infusion ◽  
Matched Sibling

Comparable Disease-Free and Overall Survival After “Well-Matched” Unrelated Donor and Matched Sibling Donor Transplantation in Acute Myeloid Leukemia with Adverse Risk Karyotype in First Complete Remission: A Report From the Acute Leukemia Working Committee of the Centre for International Blood and Marrow Transplant Research.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 526-526
Author(s):  
Vikas Gupta ◽  
Martin S. Tallman ◽  
Wensheng He ◽  
Brent Logan ◽  
John F. DiPersio ◽  
...  
Keyword(s):  
Overall Survival ◽  
Acute Myeloid Leukemia ◽  
Complete Remission ◽  
Myeloid Leukemia ◽  
Unrelated Donor ◽  
Allogeneic Hsct ◽  
Matched Sibling ◽  
Disease Free ◽  
First Complete Remission ◽  
Acute Myeloid

Abstract Abstract 526 In patients with acute myeloid leukemia (AML) in first complete remission (CR1), the indications for matched sibling donor (MSD) transplants and unrelated donor (URD) haemopoietic stem cell transplantation (HSCT) are different. We sought to determine the prognostic impact of donor type on the outcomes of AML with adverse risk karyotype in CR1, a high-risk AML population considered as a standard indication for MSD and URD HSCT. We evaluated the outcomes of 584 patients undergoing allogeneic HSCT for AML with adverse risk karyotype in CR1 between 1995 and 2006, reported to the CIBMTR. Adverse risk karyotype was defined according to SWOG/ECOG classification. Cytogenetics abnormalities were further classified as: complex karyotype (3 or more abnormalities), 32%; and Non-complex divided as abnormal chromosome 7, 25%; chromosome 5, 9%; MLL gene rearrangements, 18%; t (6;9), 5%; and others, 10%. 226 patients underwent MSD and 358 URD. URD were classified based on high resolution typing as:” well matched” [n=254 (71%)] with no known disparity at HLA A, B, C, DRB1; and, “partially matched” [n=104 (29%)] with one locus known or likely mismatched. Previous MDS was present in 19% and 14% had therapy-induced (t-AML). Conditioning regimens were myeloablative and reduced intensity in 74% and 26%, respectively. At 3 years treatment-related mortality (TRM) incidence was 28% (95% CI 24-31); relapse 36%(32-40); disease-free survival (DFS) 36%(32-41) and overall survival (OS) 39%(35-44). Multivariate analyses are summarized in the table. “Well matched” URD and MSD yielded similar DFS and OS, while outcomes were significantly inferior for “partially matched” URD. Cytogenetically defined subsets had similar outcomes. Evaluated as a time-dependent covariate, chronic GVHD had a significantly lower risk of relapse (RR 0.68, p=0.046), while acute GVHD had no effect (RR 0.99, p=0.96). “Well matched” URD and MSD lead to similar DFS and OS in AML CR1patients with adverse risk karyotype. The pool of patients who may benefit from graft-vs-leukemia effect generated with allogeneic HSCT may be considerably expanded with “well-matched” URD HSCT. If a suitable MSD is not availabel, “well-matched” URD should be strongly considered where a MSD HSCT would otherwise be undertaken. Disclosures: No relevant conflicts of interest to declare.

Significant Improvement In Day 100 and 1-Year Overall Survival In Patients Who Underwent Myeloablative Allogeneic Hematopoietic Cell Transplant In the US or Canada Between 1994 and 2005

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3509-3509
Author(s):  
Theresa Hahn ◽  
Philip L. McCarthy ◽  
Anna Hassebroek ◽  
John P. Klein ◽  
J. Douglas Rizzo ◽  
...  
Keyword(s):  
Overall Survival ◽  
Disease Status ◽  
Mortality Rates ◽  
Hematopoietic Cell ◽  
Unrelated Donor ◽  
Cell Transplant ◽  
Allogeneic Hct ◽  
Matched Sibling ◽  
Over Time ◽  
Related Mortality

Abstract Abstract 3509 Allogeneic hematopoietic cell transplantation (alloHCT) has become standard therapy for hematologic disorders and malignancies. We assessed whether overall survival (OS) at 100 days, which represents early transplant-related mortality (TRM), and at one year, which represents disease-related mortality and later TRM, had changed over time. The study population was derived from patients undergoing 38,060 first alloHCTs between 1994–2005 in US and Canadian centers and reported to the CIBMTR. Donor lymphocyte infusions were excluded. Statistical significance was measured using Ptrend over 6 time cohorts to test whether the OS estimates were stable (slope = 0), increasing (slope>0) or decreasing (slope<0) over time. The Day 100 and 1 year OS estimates are shown in the Table. Disease and disease status subgroups were defined a priori, and the OS estimates are not adjusted for any covariates such as age, Karnofsky status, etc. Marked improvements in 100-day survival were seen for all disease and disease status groups examined. Day 100 mortality rates in HLA-matched sibling alloHCT recipients during the most recent period (2004-5) were as low as 2% for CML treated in CP1, 6–8% for AML in CR1 and ALL in CR2, and a modest 12% for MDS. Even in alloHCT recipients with unrelated donors treated in 2004-5, the Day 100 mortality rates ranged from 9–22%, a significant decrease from historical mortality rates of 29–37%. Significant improvements in 1-year OS were noted for all groups undergoing unrelated-donor alloHCT; however, among those undergoing HLA-matched sibling alloHCT, significant improvements in 1-year OS were only seen in patients with CML in CP1 or MDS. OS has improved for many patients undergoing myeloablative alloHCT, which likely reflects improvement in supportive care and better patient/donor selection. Day 100 OS has significantly improved in all patients who received a myeloablative HLA-matched related or unrelated donor alloHCT. Significant improvement in 1-year OS was also experienced by most patients. Table: Overall survival (95% CI) estimates over time HLA-Matched Sibling Myeloablative Allogeneic HCT 1994-5 1996-7 1998-9 2000-1 2002-3 2004-5 Ptrend AML in CR1     N 370 370 383 376 384 440 <0.001     @100 days 85 (81–88) 87 (84–90) 90 (86–93) 88 (84–91) 92 (89–94) 94 (91–96) 0.1662     @1 year 69 (65–74) 70 (66–75) 72 (67–76) 67 (62–72) 74 (69–78) 75 (71–80) ALL in CR2+     N 179 186 149 159 156 163 0.0018     @100 days 77 (70–83) 82 (76–87) 88 (82–93) 85 (79–90) 85 (79–90) 92 (87–96) 0.2937     @1 year 62 (55–69) 63 (56–70) 69 (61–77) 59 (51–67) 64 (56–71) 70 (62–77) CML in CP1     N 483 540 492 317 155 125 <0.001     @100 days 84 (81–87) 88 (85–90) 89 (87–92) 91 (87–94) 99 (96–100) 98 (94–100) <0.001     @1 year 71 (66–75) 72 (68–76) 80 (76–83) 82 (77–86) 89 (83–93) 92 (86–96) MDS     N 225 290 273 235 239 227 <0.001     @100 days 71 (65–77) 75 (70–80) 76 (71–81) 82 (77–87) 85 (80–89) 88 (84–92) 0.0488     @1 year 54 (48–61) 51 (45–57) 57 (51–63) 58 (51–65) 61 (55–68) 64 (58–71) Unrelated Donor Myeloablative Allogeneic HCT 1994-5 1996-7 1998-9 2000-1 2002-3 2004-5 Ptrend AML in CR1     N 52 75 88 135 182 336 <0.001     @100 days 63 (50–76) 64 (53–74) 69 (59–78) 75 (68–82) 82 (76–87) 86 (82–90) 0.0427     @1 year 48 (35–62) 35 (25–47) 48 (37–59) 51 (42–60) 54 (46–61) 56 (50–62) ALL in CR2+     N 129 151 132 116 164 197 <0.001     @100 days 66 (58–74) 70 (62–77) 71 (62–78) 75 (67–82) 78 (71–84) 91 (87–95) <0.001     @1 year 43 (34–51) 45 (37–53) 49 (40–58) 40 (31–50) 54 (46–62) 67 (60–74) CML in CP1     N 211 250 292 152 87 118 0.0006     @100 days 71 (65–77) 70 (64–75) 74 (69–79) 75 (68–81) 80 (71–88) 87 (81–93) 0.0057     @1 year 51 (44–57) 54 (48–61) 59 (53–64) 60 (52–68) 65 (54–75) 71 (62–80) MDS     N 104 138 135 140 161 234 <0.001     @100 days 64 (54–73) 62 (54–70) 59 (51–67) 67 (59–75) 74 (67–81) 78 (72–83) <0.001     @1 year 41 (31–50) 44 (35–52) 35 (27–43) 45 (37–54) 52 (44–60) 57 (50–63) Disclosures: No relevant conflicts of interest to declare.

Effect of Race on Outcomes After Allogeneic Hematopoietic Cell Transplantation for Severe Aplastic Anemia

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1020-1020
Author(s):  
Michael J Eckrich ◽  
Kwang W Ahn ◽  
Zhiwei Wang ◽  
H. Joachim Deeg ◽  
Mary M. Horowitz ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Overall Survival ◽  
African Americans ◽  
Aplastic Anemia ◽  
Hematopoietic Cell Transplantation ◽  
Chronic Gvhd ◽  
Survival Rates ◽  
Unrelated Donor ◽  
Matched Sibling ◽  
Overall Mortality

Abstract Abstract 1020 Severe aplastic anemia (SAA) is the most common non-malignant indication for hematopoietic cell transplantation (HCT). Although survival after HCT for SAA has improved in recent years, it is not known whether the observed higher survival rates are uniform across racial groups or whether there are differences similar to those seen with HCT for hematologic malignancies. Our primary objective was to compare overall survival after HCT for SAA in patients of African American and Caucasian races. The study population included patients who received HCT in the U.S. between 1990 and 2008. Eighty-four African Americans (cases) and 215 Caucasians (controls) were matched on factors known to be associated with survival after HCT for SAA, including age at HCT (±3 years), donor type (HLA-matched sibling, matched unrelated donor, mismatched unrelated donor), graft type (bone marrow or peripheral blood progenitor cells) and transplant year (±1 year). For 39 cases the match ratio for controls was 1:4, for 14 cases, 1:3, for 22 cases, 1:2 and the remaining 9 cases, 1:1. The median age of cases and controls was 17 years and the median interval from diagnosis to HCT was 3.4 months. Forty-five percent of transplants were from unrelated and 55% from HLA-matched sibling donors. A third of unrelated donor-recipient pairs were HLA-mismatched. Bone marrow was the predominant source of stem cells. The median follow-up of cases and controls was 5 years. In multivariate analysis, risk of overall mortality was higher for African Americans compared to Caucasians, relative risk [RR] 1.75, 95% CI 1.14–2.69, p=0.01. Risks of overall mortality were also higher during the early post-transplant period; odds ratio (OR) 2.42, 95% CI 1.09–5.37, p=0.03) and OR 2.61, 95% CI 1.33–5.47, p=0.005) at 3-months and 1-year post-transplantation, respectively. The 5-year probability of overall survival adjusted for interval from diagnosis to HCT, performance score and conditioning regimen, the other significant variables associated with higher mortality was 58% for African Americans and 73% for Caucasians. The likelihood of neutrophil recovery was similar in both groups (OR 1.03, 95% CI 0.46–2.33, p=0.94). Acute grades II–IV graft-versus-host disease (GVHD) risks did not differ between African Americans and Caucasians (RR 0.81, 95% CI 0.56–1.17, p=0.26). However, chronic GVHD risk was higher for African Americans, although the difference did not reach statistical significance (RR 1.55, 95% CI 0.98–2.44, p=0.06). Thirty-seven (45%) of 82 African Americans died compared to 56 (27%) of 207 Caucasians. The proportion of patients dying with GVHD was higher in African Americans (12 of 37; 32%) than among Caucasians (9 of 56; 16%). Death secondary to organ failure was higher in Caucasians (12 of 56; 26%) compared to African Americans (4 of 37; 11%). There were no differences between African Americans and Caucasian in regards to deaths from graft failure, infection or hemorrhage. These data suggest recent improvements in overall survival rates after HCT for SAA are largely limited to Caucasians. Higher mortality in African Americans may be explained by greater genetic diversity, which renders the identification of donors by high-resolution HLA-typing more challenging, genetic polymorphisms impacting drug metabolism and unmeasured co-morbidities. Novel strategies aimed at lowering acute and chronic GVHD rates are needed to lower GVHD-related deaths. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Post-Transplantation Cyclophosphamide-Based Haploidentical Transplantation as Alternative to Matched Sibling or Unrelated Donor Transplantation for Hodgkin Lymphoma: A Registry Study of the Lymphoma Working Party of the European Society for Blood and Marrow Transplantation

2017 ◽  
Vol 35 (30) ◽  
pp. 3425-3432 ◽  
Author(s):  
Carmen Martínez ◽  
Jorge Gayoso ◽  
Carmen Canals ◽  
Hervé Finel ◽  
Karl Peggs ◽  
...  
Keyword(s):  
Overall Survival ◽  
Hodgkin Lymphoma ◽  
Lower Risk ◽  
Chronic Gvhd ◽  
Progression Free Survival ◽  
Unrelated Donor ◽  
Post Transplantation ◽  
Free Survival ◽  
Blood And Marrow Transplantation ◽  
Matched Sibling

Purpose To compare the outcome of patients with Hodgkin lymphoma who received post-transplantation cyclophosphamide–based haploidentical (HAPLO) allogeneic hematopoietic cell transplantation with the outcome of patients who received conventional HLA-matched sibling donor (SIB) and HLA-matched unrelated donor (MUD). Patients and Methods We retrospectively evaluated 709 adult patients with Hodgkin lymphoma who were registered in the European Society for Blood and Marrow Transplantation database who received HAPLO (n = 98), SIB (n = 338), or MUD (n = 273) transplantation. Results Median follow-up of survivors was 29 months. No differences were observed between groups in the incidence of acute graft-versus-host disease (GVHD). HAPLO was associated with a lower risk of chronic GVHD (26%) compared with MUD (41%; P = .04). Cumulative incidence of nonrelapse mortality at 1 year was 17%, 13%, and 21% in HAPLO, SIB, and MUD, respectively, and corresponding 2-year cumulative incidence of relapse or progression was 39%, 49%, and 32%, respectively. On multivariable analysis, relative to SIB, nonrelapse mortality was similar in HAPLO ( P = .26) and higher in MUD ( P = .003), and risk of relapse was lower in both HAPLO ( P = .047) and MUD ( P < .001). Two-year overall survival and progression-free survival were 67% and 43% for HAPLO, 71% and 38% for SIB, and 62% and 45% for MUD, respectively. There were no significant differences in overall survival or progression-free survival between HAPLO and SIB or MUD. The rate of the composite end point of extensive chronic GVHD and relapse-free survival was significantly better for HAPLO (40%) compared with SIB (28%; P = .049) and similar to MUD (38%; P = .59). Conclusion Post-transplantation cyclophosphamide–based HAPLO transplantation results in similar survival outcomes compared with SIB and MUD, which confirms its suitability when no conventional donor is available. Our results also suggest that HAPLO results in a lower risk of chronic GVHD than MUD transplantation.

scholarly journals Unrelated donor versus matched sibling donor in adults with acute myeloid leukemia in first relapse: an ALWP-EBMT study

2016 ◽  
Vol 9 (1) ◽  
Author(s):  
Annalisa Ruggeri ◽  
Giorgia Battipaglia ◽  
Myriam Labopin ◽  
Gerhard Ehninger ◽  
Dietrich Beelen ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Unrelated Donor ◽  
Sibling Donor ◽  
First Relapse ◽  
Matched Sibling ◽  
Acute Myeloid
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