Abstract 1197

Poster Board I-219

Abstract

Purpose:

To compare the outcomes of patients undergoing hematopoietic stem cell transplantation (HSCT) from partially matched related donors (PMRDs) or unrelated donors (URDs) for hematologic malignancies without the use of in vitro T cell depletion (TCD).

Experimental Design:

297 consecutive patients were performed HSCT from URDs (n = 78) or PMRDs (n = 219) during the same time period. Incidences of graft-versus-host disease (GVHD), relapse, non-relapse mortality (NRM), overall survival (OS) and leukemia-free survival (LFS) are compared between the PMRD and URD groups.

Results:

All patients achieved full engraftment. The cumulative incidences of grades II to IV acute GVHD in the PMRD and URD cohorts were 47% (95% CI, 33%-62%) versus 31% (CI, 20%-42%, P = .033), with a relative risk (RR) = 1.72 (1.01-2.94), P = .046. The incidence of chronic GVHD did not differ significantly between the two cohorts (P = .17). Two-year incidences of NRM and relapse were 20% (CI, 15%-26%) versus 18% (CI, 10%-27%), with P = 0.98, and 12% (CI, 8%-16%) versus 18% (CI, 10%-27%), with P = .12, for the PMRD versus URD cohort respectively. Four-year OS and LFS were 74% (CI, 67%-80%) versus 74% (CI, 62%-85%), with P = .98, and 67% (CI, 59%-75%) versus 61% (CI, 47%-74%), with P = .74, respectively.

Conclusions:

Our comparisons demonstrate that every major end point, including relapse, NRM, OS and LFS, was comparable between the PMRD and URD groups.

Table.

Multivariate analysis of aGVHD, cGVHD, TRM, Relapse and survival

OutcomeHazard ratio (95%CI)*P
Acute graft-versus-host disease 
PMRD vs unrelated 1.72 (1.01-2.94) .046 
Other significant risk factors (P< .2)   
ABO blood group  .067°÷ 
Matched 1.00  
Minor mismatched 0.68 (0.42-1.09) .11 
Major mismatched 1.24 (0.86-1.78) .25 
Chronic graft-versus-host disease 
PMRD vs unrelated 1.15 (0.71-1.86) .58 
non-relapse related mortality 
PMRD vs unrelated 1.01 (0.51-2.01) .98 
Other significant risk factors (P< .2)   
Age 1.02 (1.00-1.05) .071 
Diagnosis  .015# 
    acute myelogenous leukemia 1.00  
    acute lymphoid leukemia 0.80 (0.40-1.60) .53 
    chronic myeloid leukemia 0.47 (0.23-0.98) .044 
    myelodysplasia syndrome 1.19 (0.45-3.11) .73 
Time from diagnosis to transplant 1.01 (1.00-1.02) .053 
Relapse 
PMRD vs unrelated 0.44 (0.22-1.10) .082 
Other significant risk factors (P< .2)   
Standard-risk vs high-risk 0.44 (0.22-0.89) .022 
Diagnosis  .081# 
    acute lymphoid leukemia 1.00  
    acute myelogenous leukemia 0.74 (0.36-1.53) .42 
    chronic myeloid leukemia 0.28 (0.11-0.78) .01 
    myelodysplasia syndrome 0.00 (0.00) .98 
Time from diagnosis to transplant 1.01 (1.00-1.02) .026 
Overall survival 
PMRD vs unrelated 0.72 (0.21-2.46) .60 
Other significant risk factors (P < .2)   
Standard-risk vs high-risk 0.65 (0.39-1.08) .095 
    Diagnosis  .034# 
    acute lymphoid leukemia 1.00  
    acute myelogenous leukemia 0.98 (0.55-1.73) .94 
    chronic myeloid leukemia 0.38 (0.18-0.78) .008 
    myelodysplasia syndrome 0.92 (0.36-2.37) .87 
Time from diagnosis to transplant 1.01 (1.00-1.02) .026 
OutcomeHazard ratio (95%CI)*P
Acute graft-versus-host disease 
PMRD vs unrelated 1.72 (1.01-2.94) .046 
Other significant risk factors (P< .2)   
ABO blood group  .067°÷ 
Matched 1.00  
Minor mismatched 0.68 (0.42-1.09) .11 
Major mismatched 1.24 (0.86-1.78) .25 
Chronic graft-versus-host disease 
PMRD vs unrelated 1.15 (0.71-1.86) .58 
non-relapse related mortality 
PMRD vs unrelated 1.01 (0.51-2.01) .98 
Other significant risk factors (P< .2)   
Age 1.02 (1.00-1.05) .071 
Diagnosis  .015# 
    acute myelogenous leukemia 1.00  
    acute lymphoid leukemia 0.80 (0.40-1.60) .53 
    chronic myeloid leukemia 0.47 (0.23-0.98) .044 
    myelodysplasia syndrome 1.19 (0.45-3.11) .73 
Time from diagnosis to transplant 1.01 (1.00-1.02) .053 
Relapse 
PMRD vs unrelated 0.44 (0.22-1.10) .082 
Other significant risk factors (P< .2)   
Standard-risk vs high-risk 0.44 (0.22-0.89) .022 
Diagnosis  .081# 
    acute lymphoid leukemia 1.00  
    acute myelogenous leukemia 0.74 (0.36-1.53) .42 
    chronic myeloid leukemia 0.28 (0.11-0.78) .01 
    myelodysplasia syndrome 0.00 (0.00) .98 
Time from diagnosis to transplant 1.01 (1.00-1.02) .026 
Overall survival 
PMRD vs unrelated 0.72 (0.21-2.46) .60 
Other significant risk factors (P < .2)   
Standard-risk vs high-risk 0.65 (0.39-1.08) .095 
    Diagnosis  .034# 
    acute lymphoid leukemia 1.00  
    acute myelogenous leukemia 0.98 (0.55-1.73) .94 
    chronic myeloid leukemia 0.38 (0.18-0.78) .008 
    myelodysplasia syndrome 0.92 (0.36-2.37) .87 
Time from diagnosis to transplant 1.01 (1.00-1.02) .026 

CI indicates confidence interval;

*

The hazard ratio is for PMRD transplantation compared with unrelated transplantation;

°÷

Two degrees of freedom test;

#

Three degrees of freedom test

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Disclosures:

No relevant conflicts of interest to declare.

Topics:
donors, hematologic neoplasms, transplantation, acute lymphocytic leukemia, graft-versus-host disease, chronic, hematopoietic stem cell transplantation, leukemia, myelocytic, acute, leukemia, myelocytic, chronic, myelodysplastic syndrome, preleukemia

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2009 by The American Society of Hematology
2009
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