• Olle Ringdén, Steven Z Pavletic, Claudio Anasetti, A John Barrett, Tao Wang, Dan Wang, Joseph H Antin, Paolo Di Bartolomeo, Brian J Bolwell, Christopher Bredeson, Mitchell S Cairo, Robert P Gale, Vikas Gupta, Theresa Hahn, Gregory A Hale, Jorg Halter, Madan Jagasia, Mark R Litzow, Franco Locatelli, David I Marks, Philip L McCarthy, Morton J Cowan, Effie W Petersdorf, James A Russell, Gary J Schiller, Harry Schouten, Stephen Spellman, Leo F Verdonck, John R Wingard, Mary M Horowitz, and Mukta Arora.
• Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden. Olle.Ringden@ki.se
• Blood. 2009 Mar 26; 113 (13): 3110-8.

AbstractDo some patients benefit from an unrelated donor (URD) transplant because of a stronger graft-versus-leukemia (GVL) effect? We analyzed 4099 patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and chronic myeloid leukemia (CML) undergoing a myeloablative allogeneic hematopoietic cell transplantation (HCT) from an URD (8/8 human leukocyte antigen [HLA]-matched, n=941) or HLA-identical sibling donor (n=3158) between 1995 and 2004 reported to the CIBMTR. In the Cox regression model, acute and chronic GVHD were added as time-dependent variables. In multivariate analysis, URD transplant recipients had a higher risk for transplantation-related mortality (TRM; relative risk [RR], 2.76; P< .001) and relapse (RR, 1.50; P< .002) in patients with AML, but not ALL or CML. Chronic GVHD was associated with a lower relapse risk in all diagnoses. Leukemia-free survival (LFS) was decreased in patients with AML without acute GVHD receiving a URD transplant (RR, 2.02; P< .001) but was comparable to those receiving HLA-identical sibling transplants in patients with ALL and CML. In patients without GVHD, multivariate analysis showed similar risk of relapse but decreased LFS for URD transplants for all 3 diagnoses. In conclusion, risk of relapse was the same (ALL, CML) or worse (AML) in URD transplant recipients compared with HLA-identical sibling transplant recipients, suggesting a similar GVL effect.

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