The outcome of two or more HLA loci mismatched unrelated donor hematopoietic cell transplantation for acute leukemia: an ALWP of the EBMT study.
Arnon NaglerBhagirathbhai R DholariaMyriam LabopinBenedetto BrunoAlessandro RambaldiPietro PioltelliGiorgio La NasaGerard SocièStephan MielkeMarco RuggeriRiccardo SaccardiGeorg-Nikolaus FrankeJürgen FinkeBipin N SavaniAnnalisa RuggeriMohamad MohtyPublished in: Bone marrow transplantation (2020)
A mismatched unrelated (MMUD) donor represents an alternative therapeutic option for patients who need allogeneic hematopoietic cell transplantation (allo-HCT) and do not have a human leukocyte antigen (HLA) matched donor. We studied outcomes of patients with acute leukemia transplanted from ≥2 HLA allele MMUD. The study population consisted of 465 patients. The median follow-up period was 63 and 75 months in the AML and ALL groups, respectively. The incidence of grade II-IV and grade III-IV acute (a) graft-versus-host disease (GVHD) during the first 100 days was 37% and 16%, respectively. Total and extensive chronic (c) GVHD rates at 2 years were 38% and 17%, respectively. In the entire population, the 5-year relapse incidence (RI), non-relapse mortality (NRM), leukemia-free survival (LFS), overall survival and refined GVHD-free, relapse-free survival (GRFS) was 33%, 31%, 37%, 41%, and 27%, respectively. In the multivariate analysis, HLA-DR mismatch was a poor prognostic factor, giving a significantly higher NRM [hazard ratio (HR), 1.67, p = 0.02]; poorer LFS (HR, 1.42, p = 0.03); OS (HR, 1.46, p = 0.03) and higher aGVHD grade II-IV (HR, 1.46, p = 0.05). In this study, allo-HCT from ≤6/8 HLA allele MMUD in acute leukemia patients resulted in acceptable LFS and refined GRFS. HLA-DR mismatch was a poor prognostic factor.
Keyphrases
- free survival
- prognostic factors
- end stage renal disease
- chronic kidney disease
- newly diagnosed
- risk factors
- acute myeloid leukemia
- ejection fraction
- allogeneic hematopoietic stem cell transplantation
- bone marrow
- type diabetes
- cardiovascular disease
- intensive care unit
- patient reported outcomes
- dna methylation
- low dose
- cardiovascular events
- high dose
- glycemic control
- pi k akt