Haploidentical vs autologous hematopoietic stem cell transplantation in patients with acute leukemia beyond first remission

S. Singhal*, P. J. Henslee-Downey, R. Powles, K. Y. Chiang, K. Godder, J. Treleaven, S. Kulkarni, F. van Rhee, B. Sirohi, C. R. Pinkerton, S. Meller, B. Jovanovic, J. Mehta

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

This is a retrospective comparison of partially mismatched related donor transplantation (PMRDT) and autotransplantation (ABMT) in advanced acute leukemia. Patients underwent T-cell-depleted PMRDT (n = 164) or ABMT (n = 131) for acute myeloid leukemia (n = 130) or acute lymphoblastic leukemia (n = 165). Fewer PMRDT patients were in remission (29 vs 85%; P <0.0001). The 5-year cumulative incidence of transplant-related mortality (TRM) was 52% after PMRDT and 16% after ABMT (P <0.0001). The 5-year cumulative incidence of relapse was 32% after PMRDT and 54% after ABMT (P = 0.006). The actuarial unadjusted 5-year disease-free survival (DFS) was 16% after PMRDT and 30% after ABMT. In Cox's regression analysis, PMRDT (P <0.0001) and age >15 years (P = 0.002) were associated with higher TRM, active disease (P = 0.0021), ABMT (P = 0.0074) and male sex (P = 0.011) with higher relapse, and age >15 years (P = 0.0007) and PMRDT (P = 0.047) with lower DFS. Amongst second remission patients, TRM was higher after PMRDT (P = 0.0003), relapse was higher after ABMT (P = 0.034), and 5-year DFS was comparable (32% ABMT and 25% PMRDT). ABMT, if feasible, may be preferable to PMRDT in advanced acute leukemia patients since lower relapse after PMRDT is offset by higher TRM. If an autograft is not feasible because of nonavailabitity of autologous cells or very advanced disease, PMRDT is a potential alternative.

Original languageEnglish (US)
Pages (from-to)889-895
Number of pages7
JournalBone Marrow Transplantation
Volume31
Issue number10
DOIs
StatePublished - May 2003

Keywords

  • Acute leukemia
  • Allograft
  • Autograft
  • Graft-versus-leukemia
  • HLA-mismatched transplant

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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