Haploidentical vs autologous hematopoietic stem cell transplantation in patients with acute leukemia beyond first remission

Singhal, S., Henslee-Downey, P. J., Powles, R., Chiang, K. Y., Godder, K., Treleaven, J., Kulkarni, S., van Rhee, F., Sirohi, B., Pinkerton, C. R., Meller, S., Jovanovic, B. and Mehta, J. (2003) Haploidentical vs autologous hematopoietic stem cell transplantation in patients with acute leukemia beyond first remission. Bone marrow transplantation, 31 10: 889-895. doi:10.1038/sj.bmt.1704031


Author Singhal, S.
Henslee-Downey, P. J.
Powles, R.
Chiang, K. Y.
Godder, K.
Treleaven, J.
Kulkarni, S.
van Rhee, F.
Sirohi, B.
Pinkerton, C. R.
Meller, S.
Jovanovic, B.
Mehta, J.
Title Haploidentical vs autologous hematopoietic stem cell transplantation in patients with acute leukemia beyond first remission
Formatted title
Haploidentical vs autologous hematopoietic stem cell transplantation in patients with acute leukemia beyond first remission
Journal name Bone marrow transplantation   Check publisher's open access policy
ISSN 0268-3369
Publication date 2003-05-02
Sub-type Article (original research)
DOI 10.1038/sj.bmt.1704031
Volume 31
Issue 10
Start page 889
End page 895
Total pages 7
Place of publication Basingstoke, U.K.
Publisher Nature Publishing Group
Language eng
Subject 1103 Clinical Sciences
Formatted abstract
This is a retrospective comparison of partially mismatched related donor transplantation (PMRDT) and autotransplantation (ABMT) in advanced acute leukemia. Patients underwent T-cell-depleted PMRDT (n=164) or ABMT (n=131) for acute myeloid leukemia (n=130) or acute lymphoblastic leukemia (n=165). Fewer PMRDT patients were in remission (29 vs 85%; P<0.0001). The 5-year cumulative incidence of transplant-related mortality (TRM) was 52% after PMRDT and 16% after ABMT (P<0.0001). The 5-year cumulative incidence of relapse was 32% after PMRDT and 54% after ABMT (P=0.006). The actuarial unadjusted 5-year disease-free survival (DFS) was 16% after PMRDT and 30% after ABMT. In Cox's regression analysis, PMRDT (P<0.0001) and age >15 years (P=0.002) were associated with higher TRM, active disease (P=0.0021), ABMT (P=0.0074) and male sex (P=0.011) with higher relapse, and age >15 years (P=0.0007) and PMRDT (P=0.047) with lower DFS. Amongst second remission patients, TRM was higher after PMRDT (P=0.0003), relapse was higher after ABMT (P=0.034), and 5-year DFS was comparable (32% ABMT and 25% PMRDT). ABMT, if feasible, may be preferable to PMRDT in advanced acute leukemia patients since lower relapse after PMRDT is offset by higher TRM. If an autograft is not feasible because of nonavailability of autologous cells or very advanced disease, PMRDT is a potential alternative.
Keyword Acute leukemia
Autograft
Allograft
HLA-mismatched transplant
Graft-versus-leukemia
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
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Created: Wed, 13 Jan 2010, 01:28:03 EST by June Temby on behalf of Faculty Of Health Sciences