Originally published as JCO Early Release 10.1200/JCO.2007.15.5184 on September 2 2008

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Matched Unrelated or Matched Sibling Donors Result in Comparable Survival After Allogeneic Stem-Cell Transplantation in Elderly Patients With Acute Myeloid Leukemia: A Report From the Cooperative German Transplant Study Group

Johannes Schetelig, Martin Bornhäuser, Christoph Schmid, Bernd Hertenstein, Rainer Schwerdtfeger, Hans Martin, Matthias Stelljes, Ute Hegenbart, Kerstin Schäfer-Eckart, Monika Füssel, Barbel Wiedemann, Christian Thiede, Joachim Kienast, Herrad Baurmann, Arnold Ganser, Hans Jochem Kolb, Gerhard Ehninger

From the Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I; Klinikum der Universität München-Groβhadern, Medizinische Klinik und Poliklinik III; Medizinische Hochschule Hannover, Klinik für Hämatologie, Hämostaseologie und Onkologie; Stiftung Deutsche Klinik für Diagnostik GmbH, Zentrum für Blutstammzell- und Knochenmarktransplantation, Wiesbaden; Klinikum der Johann Wolfgang Goethe Universität Frankfurt am Main, Medizinische Klinik II; Westfälische Wilhelms-Universität, Medizinische Klinik und Poliklinik –Innere Medizin A, Münster; Universität Heidelberg, Medizinische Klinik und Poliklinik, Abteilung Innere Medizin V, Hämatologie, Onkologie und Rheumatologie; Klinikum Nürnberg, Medizinische Klinik 5, Schwerpunkt Hämatologie/Onkologie; DKMS Deutsche Knochenmarkspenderdatei Life Science Lab GmbH; Klinikum Augsburg, II. Medizinische Klinik; Klinikum Bremen-Mitte, Medizinische Klinik I; Institut für Medizinische Informatik und Biometrie der Med. Fakultät Carl Gustav Carus, Dresden, Germany

Corresponding author: Johannes Schetelig, MD, Medizinische KIinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Fetscherstr 74, 01307 Dresden, Germany; e-mail: johannes.schetelig{at}uniklinikum-dresden.de

Purpose In patients with acute myeloid leukemia (AML), differential indications for matched sibling and unrelated hematopoietic stem-cell transplantation (HCT) are considered, and arbitrary age limits for HCT exist. We sought to determine whether donor type is a prognostic factor in elderly patients in the era of high-resolution DNA-based HLA typing.

Patients and Methods We performed univariate and multivariate analyses of event-free survival (EFS) and overall survival (OS) in patients older than 50 years with standard- or high-risk AML who had received an allogeneic HCT between 1995 and 2005. Available DNA from donors and recipients of unrelated HCT was retyped so that the HLA-A, -B, -C, and -DRB1 alleles could be characterized in detail. Unrelated donors (UDs) were classified as matched (8/8), possibly matched (matched, but incomplete information), partially matched (one mismatch), or poorly matched (two or more mismatches) according to the final typing results.

Results Data from 368 patients with a median age of 57 years (range, 50 to 73 years) were included. Multivariate Cox regression analysis revealed that patients’ disease status at HCT (P < .001) and the cytogenetic risk (P < .001) highly significantly predicted EFS and OS. Compared with patients with matched sibling donors, the adjusted relative risk of EFS was 0.7 (95% CI, 0.4 to 1.1) for patients with matched UDs and 1.0 (95% CI, 0.7 to 1.6) for patients with partially matched UDs.

Conclusion Donor type is not a major prognostic factor for HCT in elderly patients with standard- or high-risk AML.

published online ahead of print at www.jco.org on September 2, 2008.

Supported by a research grant from the DKMS German Bone Marrow Donor Center, Tübingen, Germany, and by Histogenetics Inc, Ossining, NY.

Presented partly at the Annual Meeting 2007 of the European Group for Blood and Marrow Transplantation and the annual meeting 2007 of the American Society of Hematology.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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