Hematopoietic transplantation from adult unrelated donors as treatment for acute myeloid leukemia

Abstract

Transplantation from unrelated donors (URD) is increasingly being used as treatment for hematological malignancies, including acute myeloid leukemia (AML). This increase is the consequence of the availability of more than 11 million URD volunteers and the more efficient donor search process in the recent years. Median time to identify a suitable URD is now 2 months. More than 50% of Caucasian patients have an human leukocyte antigen (HLA)-allele donor match and a one-antigen or allele HLA-mismatched donor may also be acceptable. Complications of URD transplants are particularly frequent and severe, with long-term OS in the registries being 10-20% inferior to HLA-identical sibling transplantation. High resolution DNA techniques for donor and recipient HLA matching have contributed to the survival in experienced centres after unrelated donor SCT approaching that achieved with sibling donors. The introduction of reduced intensity conditioning (RIC) has extended URD transplants to elderly and/or debilitated patients with AML. With this approach, TRM decreases, although graftversus-host disease-related morbidity and mortality remain a problem. Despite this complication, results after URD transplantation in this age group seem better than those achieved with chemotherapy and/or autologous transplantation. To confirm this possibility, prospective multicenter comparisons of URD transplants after RIC with other treatment options for elderly AML patients have recently been started.

One-Antigen Mismatched Related versus HLA-Matched Unrelated Donor Hematopoietic Stem Cell Transplantation in Adults with Acute Leukemia: Center for International Blood and Marrow Transplant Research Results in the Era of Molecular HLA Typing

“…2-5 Moreover, recent reports show that allo-SCT outcomes of patients with with matched UD-SCT are similar to HLA identical sibling donors. 6-11 …”

Clinical characteristics and outcomes of patients with acute myelogenous leukemia admitted to intensive care: a case-control study

“…Over the past 20 years, more aggressive chemotherapeutic regimens, availability of bone marrow transplantation (BMT), and development of subtype-directed therapies have led to improved survival[2]. However, these more aggressive therapeutic strategies have also contributed to a higher likelihood of complications [3,4], translating into a greater demand for support in an intensive care unit (ICU) setting[5-10]. Moreover, ICU support of these patients has been associated with more intensive and greater resource utilization[11].…”

Peripheral Blood Stem Cell Transplantation from Human Leukocyte Antigen-Matched Sibling Donors and Unrelated Donors in Acute Myeloid Leukemia Patients

“…The general perception is that a URD HSCT presents greater risks in terms of graft-versus-host disease (GVHD) and nonrelapse mortality (NRM) than human leukocyte antigen (HLA)-matched sibling donor (MSD) HSCT; thus, under certain circumstances, URD HSCT is not recommended for patients with acute myeloid leukemia (AML) [2]. However, due to advanced HLA typing methods and improved GVHD prophylactic strategies for URD HSCT [3], several recent studies have shown comparable clinical results between URD HSCT and MSD HSCT for treatment of hematologic malignancies [4,5].…”