Matched unrelated or matched sibling donors result in comparable outcomes after non-myeloablative HSCT in patients with AML or MDS

Abstract

The impact of allelic HLA matching in patients with AML and myelodysplastic syndrome (MDS) who receive allogeneic PBSC after a reduced-intensity conditioning (RIC) regimen is unclear. From January 2000 to December 2010, 108 consecutive patients with AML (n ¼ 63) and MDS (n ¼ 45) received PBSC after RIC in our center, either from siblings (n ¼ 70) or from matched unrelated donors (MUD; 10/10 high resolution, n ¼ 38). Conditioning regimen was fludarabine based in 95% of patients and GvHD prophylaxis was mostly cyclosporine plus mycophenolate. Patient characteristics were similar between sibling and MUD for age (median 57 years), gender and disease distribution. Conditioning regimen (more anti-thymocyte globulin (ATG) in MUD), donor age (younger for MUD) and number of CD34 þ cells infused (higher in MUD) were different. The median follow-up was 36 months (range 2-72). Engraftment, GvHD, TRM, relapse rate and OS at 3 years were comparable between sibling and MUD. After adjustment for age, cytogenetic risk, ATG and number of CD34 þ cells infused, donor type still did not influence OS. In patients with AML or MDS, HSCT from MUD using PBSC after a RIC regimen led to similar outcomes than from Siblings.

Lower dose anti-thymocyte globulin for GvHD prophylaxis results in improved survival after allogeneic stem cell transplantation

“…Several studies confirm these data, showing similar outcomes regardless of donor type. [18][19][20] We found a survival benefit with lower dose ATG-F. Previous studies, of which some are published as abstracts only, found some advantage for ATG treatment.…”

Nonmyeloablative allogeneic hematopoietic cell transplantation

“…53 A French study initially saw no significant impact of donor age among MDS and AML patients undergoing transplantation. 54 In contrast, a later analysis by the French group found that donor age ≥60 years had a significant adverse impact on overall recipient survival. 55 A CIBMTR analysis from 2013 reported that outcomes were superior in recipients of grafts from HLAidentical sibling donors >50 years old compared to those with grafts from HLA-matched unrelated donors <50 years of age.…”

Graft-versus-host disease in recipients of male unrelated donor compared with parous female sibling donor transplants

“…[1][2][3] With increasing use of unrelated donors (URDs) for allogeneic HCT, large studies have evaluated outcomes for patients with sibling donor vs URD, with most demonstrating similar longterm survival among the 2 donor groups. [4][5][6][7][8][9][10][11][12][13][14] However, when given the option of a sibling donor or URD, sibling donors are typically preferred for convenience and possibly to reduce GVHD and to improve survival. Both donor-recipient sex mismatching and the effect of donor parity have been evaluated as possible influences on transplant morbidity and mortality.…”