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Improved survival for young acute leukemia patients following a new donor hierarchy for allogeneic hematopoietic stem cell transplantation: A phase III randomized controlled study. | LitMetric

AI Article Synopsis

  • The study assessed the best donor options for young acute leukemia patients undergoing stem cell transplantation, focusing on various donor types: MSD, URD, HPD, and HSD.
  • The findings revealed that patients receiving transplants from MSDs or HSDs had better 5-year overall survival rates compared to those using URDs or HPDs, with HSDs showing particularly favorable outcomes for high-risk patients.
  • A follow-up randomized study demonstrated that a new donor hierarchy significantly improved 2-year overall survival and disease-free survival rates compared to traditional donor selection.

Article Abstract

The aim of our study was to evaluate the most optimal donor for young acute leukemia (AL) patients with multiple donors available for allogeneic hematopoietic stem cell transplantation (allo-HSCT), including HLA-matched sibling donors (MSDs), HLA-matched unrelated donors (URDs), haploidentical parental donors (HPDs), and haploidentical sibling donors (HSDs). From March 2008 to December 2016, 430 AL patients ≤ 35 years of age were included in the discovery, retrospective study. Patients who received transplantation from a MSD or a HSD had better 5-year OS rates compared with patients who received transplantation from a URD or a HPD. A superior graft-versus-leukemia effect was observed for high-risk patients undergoing HSD-HSCT with a lower relapse rate (p = 0.014) and a higher disease-free survival (DFS) rate (p = 0.029) compared with those undergoing MSD-HSCT. Outcomes of high-risk patients receiving an URD or HPD were equivalent. For intermediate/standard-risk patients, either a MSD or HSD may be the front-line donor selection with comparable outcomes. HLA-matched unrelated donors were preferred over HPDs with reduced non-relapse mortality and higher overall survival (OS) and DFS rates. We further conducted an independent prospective randomized study to evaluate the survival advantage with the new donor hierarchy. Two hundred and fifty patients were randomly assigned to follow our new donor hierarchy or the traditional donor hierarchy at a 2:1 ratio. The new donor hierarchy contributed to significantly superior 2-year OS and DFS rates (OS: 76.2% vs. 67.8%, p = 0.046; DFS: 71.8% vs. 64.5%, p = 0.039).

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Source
http://dx.doi.org/10.1002/ajh.26317DOI Listing

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