HLA-10/10 matched unrelated donor versus sibling donor hematopoietic stem cell transplantation for adult acute myeloid leukemia

Objective To evaluate the outcomes of human leukocyte antigen(HLA)matched unrelated donor hematopoietic stem cell transplantation(MUD-HSCT)for adult acute myeloid leukemia(AML)in a single center.Methods Consecutive AML adults who received MUDHSCT in our center from January 2008 to April 2017 were studied retrospectively,comparing with patients undergoing matched sibling donor(MSD)-HSCT in the same period.The rates of overall survival(OS),disease free survival(DFS),relapse,non-relapse mortality(NRM),engraftment,acute and chronic graft-versushost disease(aGVHD and cGVHD)were analyzed.Results A total of 247 consecutive cases were enrolled,including 46 patients with MUD-HSCT and 201 with MSD-HSCT.All the patients experienced neutrophil engraftment except for one patient who died early in the MSD group,but the median day of engraftment was longer in the MUD group(15.0 vs 14.0,P=0.017).The accumulative engraftment rate of platelet was comparable between the two groups(93.5%vs 98.0%,P=0.128).The accumulative incidences of aGVHD(50.0%vs 46.3%,P=0.421)and cGVHD(37.8%vs 43.0%,P=0.581)were not statistically different between the two groups.Compared with the MSD group,the accumulative NRM rate at+36 months after transplantation was significantly higher in the MUD group(22.0%vs 10.4%,P=0.049),while the relapse rate had no statistical difference(20.5 vs 28.3%,P=0.189).Both 3-year OS(61.6%vs 63.3%,P=0.867)and DFS(57.5%vs 61.6%,P=0.760)were comparable between the two groups.Four independent risk factors were confirmed by the multivariate analysis:patient age≥45 years old,CR2 or NR before transplantation,a history of extramedullary infiltration and the occurrence of gradeⅢ-ⅣaGVHD.No statistical differences were demonstrated in the survival rate between MUD-and MSD-HSCT in different subgroups.Conclusion The outcomes,such as GVHD,relapse,OS and DFS,are comparable between MUD-and MSD-HSCT for adult AML,but higher incidence of NRM and longer time to neutrophil engraftment are found in the MUD group.MUD-HSCT is practical and feasible for AML adults who are lack of MSD.