Donor-specific differences in long-term outcomes of myeloablative transplantation in adults with Philadelphia-negative acute lymphoblastic leukemia

作者：Lee S^*; Chung N G; Cho B S; Eom K S; Kim Y J; Kim H J; Min C K; Cho S G; Kim D W; Lee J W; Min W S; Park C W; Kim C C

来源：Leukemia, 2010, 24(12): 2110-2119.

DOI：10.1038/leu.2010.217

• Philadelphia-negative acute lymphoblastic leukemia
• adult
• stem cell transplantation
• allogeneic
• autologous

We analyzed long-term outcomes of myeloablative stem cell transplantation (SCT) in 292 adults with Philadelphia (Ph)negative acute lymphoblastic leukemia (ALL). Donors were related (RD; n = 132), unrelated (URD; n 68; 30 well-matched (WM), 19 partially matched (PM), 19 mismatched (MM)) and autologous (AUTO; n 92). After a median follow-up of 85 months, the risk of relapse was higher for AUTO-SCT than for RD-SCT (P<0.001). MM-URD-SCT yielded higher risk of non-relapse mortality than RD-SCT (P = 0.010). As a result, disease-free survival (DFS) at 5 years was inferior using AUTO (46.1%; P _ 0.010) or MM-URD (26.3%; P _ 0.036), whereas DFS from other donor sources was approximately equivalent (53.5% for RD, 63.3% for WM-URD and 57.0% for PM-URD). Other factors associated with poorer DFS included SCT beyond first complete remission (CR), older age and adverse cytogenetics. In a pairwise comparison of outcomes between RD-SCT and AUTO-SCT for patients in first CR, the inferiority of AUTO-SCT was observed, particularly in high-risk patients. Conversely, in standard-risk patients, AUTO-SCT yielded comparable outcomes to RD-SCT. SCT using RD, WM-URD or PM-URD may be considered the best donor sources for adult high-risk Ph-negative ALL. Leukemia (2010) 24, 2110-2119; doi:10.1038/leu.2010.217; published online 30 September 2010

• 出版日期2010-12