Currently at St. Agnes Health Care Baltimore, MD, USA.
Autotransplantation versus HLA-matched unrelated donor transplantation for acute myeloid leukaemia: a retrospective analysis from the Center for International Blood and Marrow Transplant Research
Version of Record online: 20 JAN 2006
British Journal of Haematology
Volume 132, Issue 6, pages 755–769, March 2006
How to Cite
Lazarus, H. M., Pérez, W. S., Klein, J. P., Kollman, C., Bate-Boyle, B., Bredeson, C. N., Gale, R. P., Geller, R. B., Keating, A., Litzow, M. R., Marks, D. I., Miller, C. B., Douglas Rizzo, J., Spitzer, T. R., Weisdorf, D. J., Zhang, M.-J. and Horowitz, M. M. (2006), Autotransplantation versus HLA-matched unrelated donor transplantation for acute myeloid leukaemia: a retrospective analysis from the Center for International Blood and Marrow Transplant Research. British Journal of Haematology, 132: 755–769. doi: 10.1111/j.1365-2141.2005.05947.x
- Issue online: 13 FEB 2006
- Version of Record online: 20 JAN 2006
- Received 29 August 2005; accepted for publication 21 November 2005
- unrelated allograft;
- acute myeloid leukaemia;
- bone marrow transplantation;
- haematopoietic stem cell transplant
Most acute myeloid leukaemia (AML) patients lack human leucocyte antigen-identical sibling donors for transplantation. Autotransplants and unrelated donor (URD) transplants are therapeutic options. To compare autologous versus URD transplantation for AML in first (CR1) or second complete remission (CR2), we studied the outcomes of 668 autotransplants were compared with 476 URD transplants reported to the Center for International Blood and Marrow Transplant Research. Proportional hazards regression adjusted for differences in prognostic variables. In multivariate analyses transplant-related mortality (TRM) was significantly higher and relapse lower with URD transplantation. Adjusted 3-year survival probabilities were: in CR1 57 (53–61)% with autotransplants and 44 (37–51)% URD (P = 0·002), in CR2 46 (39–53)% and 33 (28–38)% respectively (P = 0·006). Adjusted 3-year leukaemia-free survival (LFS) probabilities were: CR1 53 (48–57)% with autotransplants and 43 (36–50)% with URD (P = 0·021), CR2 39 (32–46)% and 33 (27–38)% respectively (P = 0·169). Both autologous and URD transplantation produced prolonged LFS. High TRM offsets the superior antileukaemia effect of URD transplantation. This retrospective, observational database study showed that autotransplantation, in general, offered higher 3-year survival for AML patients in CR1 and CR2. Cytogenetics, however, were known in only two-thirds of patients and treatment bias cannot be eliminated.