Comparison of long-term outcomes after allogeneic hematopoietic stem cell transplantation from matched sibling and unrelated donors

Abstract

Long-term survivors of hematopoietic stem cell transplants remain at risk of potentially fatal complications that detract from life quality. Long-term morbidity and mortality were compared between matched recipient cohorts surviving 2 or more years and defined by donor type, HLA matched sibling donor (MSD) or volunteer unrelated donor (URD). Patients were previously entered into the prospective multicenter International Unrelated Search and Transplant Study. Thirty-nine centers provided data on 108 URD and 355 MSD recipients surviving more than 2 years. Long-term survival, performance status, chronic GvHD (c-GvHD), secondary malignancy, endocrine dysfunction, cataracts, bone necrosis and dental pathology were compared between cohorts. Twelve year survival was 77+/-5% for the MSD and 67+/-11% for the URD cohort (P=0.1). Late death occurred in 105 of 463 recipients alive at 2 years, 73 after 355 (21%) MSD and 32 after 108 (30%) URD transplants, P=0.10. Of 105 deaths, the cause was relapse in 60 and unrelated to relapse in 45 cases. Cumulative incidence of extensive c-GvHD (P=0.002), cataracts (P=0.02) and bone necrosis (P=0.02) was higher after URD transplants. No long-term difference in endocrine dysfunction, secondary malignancy and major dental pathology was detected. This landmark study will assist physicians counseling patients pre-transplant and with their long-term care post transplant.

Viewpoint: What is the role of allogeneic haematopoietic cell transplantation in the era of reduced-intensity conditioning – is there still an upper age limit? A focus on myeloid neoplasia

“…Furthermore, results after standard-dose conditioning and unrelated donor HCT are at least as good as sibling-HCT, and may be even better in highrisk patients. 31 Results obtained with fludarabine and 2 Gy RIC in unrelated donor transplantation showed similar results. 9 What about allo-transplantation -especially with RIC -in relapsing patients?…”

“…31 When dealing with elderly patients, we are frequently confronted with frail siblings with comorbidities. A young unrelated donor may be a safer option than an old sibling with respect to stem-cell donation in such situations, and be even better for the patient with the potentially higher stem-cell count in the G-CSF-mobilized graft.…”

National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Subsequent Neoplasms Working Group Report

“…126 Pre-HCT manipulation of donor stem cells (e.g., ex-vivo T-cell depletion) has been associated with increased risk of PTLD, with particularly elevated risks when using anti-thymocyte globulin or alemtuzumab in the preparative regimen, but no difference when using MSD or URD products. 127,128 A European Society for Blood and Marrow Transplantation (EBMT) study of donor cell leukemia after 10,489 allogeneic HCTs performed during 1975–1998 found 14 cases, of which 12 were from matched related donors and two from URD.…”

Occupational status among adult survivors following allo-SCT

“…2 Paid work is essential for an individual's identity and health, enables the person to regain a sense of normality [3][4][5] and is highly desirable from a social and economic perspective. 6 A substantial number of SCT long-term survivors report disease-and treatmentrelated problems that may last for a considerable time, with a possible negative influence on general well-being, quality of life [7][8][9][10][11][12] and participation in paid work. 13 Moreover, being in work is associated with better well being among survivors previously treated with SCT.…”