Allogeneic stem cell transplantation for patients with refractory anaemia with matched related and unrelated donors: delay of the transplant is associated with inferior survival

P>Allogeneic stem cell transplantation (alloSCT) for patients with refractory anaemia may result in a 50% event-free survival, but the high non-relapse mortality (NRM) precludes a general application of this therapeutic modality. This study evaluated the impact of various pre-transplant variables...

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Bibliographic Details
Authors: de Witte, T, Brand, R, van Biezen, A, Mufti, G, Ruutu, T, Finke, J, von dem Borne, P, Vitek, A, Delforge, M, Alessandrino, P, Harlahakis, N, Russell, N, Martino, R, Verdonck, L, Kroger, N, Niederwieser, D
Format: article
Status:Published version
Publication Date:2009
Country:España
Institution:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repository:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p12973
Online Access:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=12973
Access Level:Open access
Keyword:refractory anaemia
allogeneic stem cell transplantation
reduced intensity conditioning regimens
HLA-identical sibling donor
matched unrelated donor
Description
Summary:P>Allogeneic stem cell transplantation (alloSCT) for patients with refractory anaemia may result in a 50% event-free survival, but the high non-relapse mortality (NRM) precludes a general application of this therapeutic modality. This study evaluated the impact of various pre-transplant variables, including disease duration, intensity of the conditioning regimen, type of donor and year of transplantation on outcome. The study population consisted of 374 patients; 244 were transplanted from human leucocyte antigen (HLA)-identical siblings and 130 patients from matched unrelated donors. The median age was 39 years. One hundred and two patients were transplanted after reduced intensity conditioning (RIC). The overall 4-year survival was 52%. The 4-year survival of patients transplanted with HLA-identical sibling donors and matched unrelated donors was 52% and 50%, respectively. Multivariate analysis showed an improved survival (P = 0 center dot 05) and a lower NRM (P = 0 center dot 02) when the transplantation was performed in recent years. Increasing age, and disease duration of > 12 months were associated with inferior survival. RIC resulted in a similar survival despite an increased relapse risk (P = 0 center dot 02). This improved outcome permits alloSCT in patients older than 50 years of age, even with the use of matched unrelated donors. AlloSCT should be preferentially performed early after diagnosis after careful analysis of prognostic variables.

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