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RESEARCH PRODUCT

Prognostic Factors Affecting Outcome after Allogeneic Transplantation for Hematological Malignancies from Unrelated Donors: Results from a Randomized Trial

Jürgen FinkeClaudia SchmoorWolfgang A. BethgeHellmut OttingerMatthias StelljesAxel R. ZanderLiisa VolinDominik A. HeimRainer SchwerdtfegerKarin KolbeJiri MayerJohan A. MaertensWerner LinkeschErnst HollerVladimir KozaMartin BornhäuserHermann EinseleHartmut BertzOlga GrishinaGérard SociéFor The Atg-fresenius Trial Group

subject

MaleOncologyTransplantation Conditioningmedicine.medical_treatmentMedizinGraft vs Host DiseaseHematopoietic stem cell transplantationSeverity of Illness Indexlaw.invention0302 clinical medicineRandomized controlled trialHLA Antigenslawimmune system diseaseshemic and lymphatic diseasesAllogeneic hematopoietic stem-cell transplantationMedicineProspective StudiesProspective cohort studyHematologyHistocompatibility TestingAge FactorsHematopoietic Stem Cell TransplantationHematologyMiddle Aged3. Good healthSurvival Ratesurgical procedures operative030220 oncology & carcinogenesisAcute DiseaseFemaleUnrelated DonorsAdultmedicine.medical_specialtyAllogeneic transplantationAdolescentGraft-versus-host-disease prophylaxis03 medical and health sciencesInternal medicineHumansTransplantation HomologousHLA-matchingSurvival rateAntilymphocyte SerumTransplantationbusiness.industryMyeloablative AgonistsTransplantationChronic DiseaseImmunologyTransplantation Conditioningbusiness030215 immunology

description

Several prognostic factors for the outcome after allogeneic hematopoietic stem-cell transplant (HSCT) from matched unrelated donors have been postulated from registry data; however, data from randomized trials are lacking. We present analyses on the effects of patient-related, donor-related, and treatment-related prognostic factors on acute GVHD (aGVHD), chronic GVHD (cGVHD), relapse, nonrelapse mortality (NRM), disease-free survival (DFS), and overall survival (OS) in a randomized, multicenter, open-label, phase III trial comparing standard graft-versus-host-disease (GVHD) prophylaxis with and without pretransplantation ATG-Fresenius (ATG-F) in 201 adult patients receiving myeloablative conditioning before HSCT from HLA-A, HLA-B antigen, HLA-DRB1, HLA-DQB1 allele matched unrelated donors. High-resolution testing (allele) of HLA-A, HLA-B, and HLA-C were obtained after study closure, and the impact of an HLA 10/10 4-digit mismatch on outcome and on the treatment effect of ATG-F versus control investigated. Advanced disease was a negative factor for relapse, DFS, and OS. Donor age ≥40 adversely affected the risk of aGVHD III-IV, extensive cGVHD, and OS. Younger donors are to be preferred in unrelated donor transplantation. Advanced disease patients need special precautions to improve outcome. The degree of mismatch had no major influence on the positive effect of ATG-F on the reduction of aGVHD and cGVHD. © 2012 American Society for Blood and Marrow Transplantation.

yearjournalcountryeditionlanguage
2012-11-01Biology of Blood and Marrow Transplantation
10.1016/j.bbmt.2012.06.001http://dx.doi.org/10.1016/j.bbmt.2012.06.001