Allogeneic Hematopoietic Stem Cell Transplantation from Sources other than Matched Related Donors in the Management of Elderly Acute Myeloid Leukemia Patients in First Complete Remission

Abstract

The outcome of elderly acute myeloid leukemia AML patients is poor compared to that of younger patients. 1 Recent reports suggested that allogeneic hematopoietic stem cell transplantation allo-HSCT from human leukocyte antigen HLA -matched related donors MRDs improves the outcome of elderly AML patients if given after successful induction of first complete remission CR1 . 2,3 However, because their siblings are more likely to be older and in poorer health, less than half of elderly patients have suitable sibling donors. 2,4 The utility of allo-HSCT from sources other than MRDs alternative donors in the management of elderly AML patients in CR1 has not been clarified. 4 While allo-HSCT from HLA-matched unrelated donors MUDs shows similar survival compared with allo-HSCT from MRDs, 5-9 allo-HSCT from partially mismatched donors and umbilical cord bloodUCB is reported to have worse outcomes than that from HLA-matched donors. [10][11][12][13][14][15] The outcome of allo-HSCT for elderly AML patients in CR1 is superior to those given in second CR, 16 but making the decision to perform allo-HSCT in CR1 is difficult for both patients and the attending physicians.The aim of this study was to further investigate the beneficial effects of giving allo-HCST in CR1 compared to chemotherapy alone, and to assess the utility of using transplants from alternative donors, in the management of elderly AML patients. The utility of allogeneic hematopoietic stem cell transplantation(allo-HSCT)from sources other than matched related donors(alternative donors)in the management of elderly acute myeloid leukemia(AML)patients in first complete remission(CR1)has not been clarified.To investigate the benefit of allo-HCST in the management of elderly AML patients in CR1, we retrospectively collected data from consecutive AML patients aged 60-66 years, who had been diagnosed between 2000 and 2014 and achieved CR. A total of 43 patients were included in this study, and 12 patients received allo-HSCT in CR1 only from alternative donors. Compared to chemotherapy alone, allo-HSCT improved overall survival(OS) (P＝0.050)and cumulative incidence of relapse(CIR) (P＝0.0059)in univariate analysis. OS and CIR at 3 years from CR1 were 82.5% vs 34.2%, and 17.5% vs 74.6%, respectively. In multivariate analysis, allo-HSCT also improved OS(hazard ratio(HR) , 0.18; 95% confidence interval (CI) , 0.039-0.80)and CIR(HR, 0.090; 95% CI, 0.029-0.28) . Allo-HSCT from an alternative donor is a credible option in the treatment of elderly AML patients in