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Decision analysis for donor selection in stem cell transplantation-HLA-8/8 allele-matched unrelated donor vs HLA-1 AG mismatched related donor.

Abstract：

:Risk of relapse during the unrelated donor coordination period biases comparisons between allogeneic hematopoietic stem cell transplantation from an HLA 8 of 8 allele-matched unrelated donor (8/8 MUD) and that from a related donor with an HLA-1 antigen mismatch in the graft-versus-host (GVH) direction (RD/1AGMM-GVH). To reduce this bias, we performed a decision analysis focusing on acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) in first complete remission (CR1). The primary outcome measure was 5-year survival probability with or without quality-of-life (QOL) adjustment. A baseline analysis showed that the decision to perform MUD transplantation was superior to that to perform RD/1AGMM-GVH transplantation for patients with AML or ALL. However, in the ALL cohort, the direction of superiority was reversed when the interval between CR1 and 8/8 MUD transplantation was >5.5 months (without QOL adjustment) or >6 months (after QOL adjustment) or when overall survival of RD/1AGMM-GVH transplantation improved by 1.3% without QOL adjustment and 2.1% after QOL adjustment. In conclusion, 8/8 MUD should be prioritized in transplantation for AML and ALL in CR1. However, the MUD coordination period and improvements in RD/1AGMM-GVH transplantation might change the donor selection priority in transplantation for ALL in CR1.

journal_name

Blood Cancer J

journal_title

Blood cancer journal

authors

Kanda J,Fuji S,Kato S,Takami A,Tanaka J,Miyamura K,Ohashi K,Fukuda T,Ozawa Y,Kanamori H,Eto T,Kobayashi N,Iwato K,Morishima Y,Sakamaki H,Atsuta Y,Kanda Y,HLA Working Group.,Donor\/Source Working Group.,Adult AML Wor

doi

10.1038/bcj.2014.85

subject

Has Abstract

pub_date

2014-12-05 00:00:00

pages

e263

issn

2044-5385

pii

bcj201485

journal_volume

4

pub_type

临床试验,杂志文章,多中心研究

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