Prognostic Impact of Donor Source on Allogeneic Hematopoietic Stem Cell Transplantation Outcomes in Adults with Chronic Myelomonocytic Leukemia: A Nationwide Retrospective Analysis in Japan

Hidehiro Itonaga; Kazunari Aoki; Jun Aoki; Takayuki Ishikawa; Ken Ishiyama; Naoyuki Uchida; Toru Sakura; Kazuteru Ohashi; Mineo Kurokawa; Yukiyasu Ozawa; Ken-Ichi Matsuoka; Yukinori Nakamura; Fumihiko Kimura; Koji Iwato; Yuichiro Nawa; Makoto Hirokawa; Koji Kato; Tatsuo Ichinohe; Yoshiko Atsuta; Yasushi Miyazaki

doi:10.1016/j.bbmt.2017.11.016

Prognostic Impact of Donor Source on Allogeneic Hematopoietic Stem Cell Transplantation Outcomes in Adults with Chronic Myelomonocytic Leukemia: A Nationwide Retrospective Analysis in Japan

Biol Blood Marrow Transplant. 2018 Apr;24(4):840-848. doi: 10.1016/j.bbmt.2017.11.016. Epub 2017 Nov 28.

Authors

Hidehiro Itonaga¹, Kazunari Aoki², Jun Aoki³, Takayuki Ishikawa⁴, Ken Ishiyama⁵, Naoyuki Uchida⁶, Toru Sakura⁷, Kazuteru Ohashi⁸, Mineo Kurokawa⁹, Yukiyasu Ozawa¹⁰, Ken-Ichi Matsuoka¹¹, Yukinori Nakamura¹², Fumihiko Kimura¹³, Koji Iwato¹⁴, Yuichiro Nawa¹⁵, Makoto Hirokawa¹⁶, Koji Kato¹⁷, Tatsuo Ichinohe¹⁸, Yoshiko Atsuta¹⁹, Yasushi Miyazaki²⁰

Affiliations

¹ Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan. Electronic address: [email protected].
² Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
³ Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan.
⁴ Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan.
⁵ Department of Hematology, Kanazawa University Hospital, Kanazawa, Japan.
⁶ Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan.
⁷ Leukemia Research Center, Saiseikai Maebashi Hospital, Maebashi, Japan.
⁸ Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
⁹ Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, Tokyo, Japan.
¹⁰ Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
¹¹ Department of Hematology and Oncology, Okayama University, Okayama, Japan.
¹² Third Department of Internal of Medicine, Yamaguchi University School of Medicine, Yamaguchi, Japan.
¹³ Division of Hematology, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Japan.
¹⁴ Department of Hematology, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan.
¹⁵ Division of Hematology, Ehime Prefectural Central Hospital, Matsuyama, Japan.
¹⁶ Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan.
¹⁷ Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
¹⁸ Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
¹⁹ Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.
²⁰ Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan; Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan.

PMID: 29196081
DOI: 10.1016/j.bbmt.2017.11.016

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative therapeutic option for patients with chronic myelomonocytic leukemia (CMML). We retrospectively compared the post-transplantation outcomes of 159 patients with CMML who underwent allo-HSCT using 4 types of donor sources: HLA-matched related donor graft, unrelated bone marrow (U-BM), unrelated cord blood (U-CB), and HLA-mismatched related donor graft. The median patient age at allo-HSCT was 54 years (range, 16 to 75 years). In multivariate analyses, the use of HLA-matched related donor grafts correlated with better overall survival than U-BM (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.21 to 3.48; P = .008), U-CB (HR, 3.80; 95% CI, 2.07 to 6.95; P < .001), or HLA-mismatched related donor grafts (HR, 6.18; 95% CI, 2.70 to 14.15; P < .001). Mortality after the relapse or progression of CMML did not significantly differ among the 4 types of donor source. Transplantation-related mortality was highest in recipients of U-CB (HR, 3.32; 95% CI, 1.33 to 8.26; P = .010). In patients with CMML, allo-HSCT using an alternative donor may contribute to durable remission; however, further improvements in transplantation-related mortality are required for this type of transplantation.

Keywords: Allogeneic hematopoietic stem cell transplantation; Chronic myelomonocytic leukemia; Donor source.

Publication types

Clinical Trial
Comparative Study
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Age Factors
Aged
Allografts
Disease-Free Survival
Female
Hematopoietic Stem Cell Transplantation*
Humans
Japan / epidemiology
Leukemia, Myelogenous, Chronic, BCR-ABL Positive / mortality*
Leukemia, Myelogenous, Chronic, BCR-ABL Positive / therapy*
Male
Middle Aged
Retrospective Studies
Survival Rate