 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15 April 1994 | Volume 120 Issue 8 | Pages 646-652
Objective: To compare outcomes of identical-twin with HLA-identical sibling bone marrow transplants for leukemia.
Design: Matched-pair analysis comparing relapse, treatment-related mortality, and leukemia-free survival in cohorts matched for disease and variables correlated with transplant outcome, with and without adjustment for graft-versus-host disease.
Setting: 163 institutions worldwide between 1978 and 1990, reporting to the International Bone Marrow Transplant Registry.
Participants: 103 identical-twin transplants: 24 for acute lymphoblastic leukemia (ALL) in first remission, 45 for acute myelogenous leukemia (AML) in first remission, and 34 for chronic myelogenous leukemia (CML) in first chronic phase. Results were compared with those in 1030 concurrent HLA-identical sibling transplants matched for prognostic factors.
Results: Three-year probabilities of relapse after identical-twin compared with HLA-identical sibling transplants were as follows: ALL, 36% (95% CI, 17% to 55%) compared with 26% (CI, 20% to 32%); AML, 52% (CI, 37% to 67%) compared with 16% (CI, 12% to 20%); and CML, 40% (CI, 23% to 57%) compared with 7% (CI, 4% to 10%). Increased relapse risks in AML and CML persisted after adjusting for graft-versus-host disease (relative risk, 3.1 [CI, 1.9 to 5.1] and 5.5 [CI, 2.8 to 11.0], respectively). Although twins had less treatment-related mortality than HLA-identical siblings, leukemia-free survival was similar. Three-year leukemia-free survival probabilities after twin compared with HLA-identical sibling transplants were as follows: ALL, 57% (CI, 37% to 77%) compared with 58% (CI, 52% to 64%); AML, 42% (CI, 27% to 57%) compared with 55% (CI, 50% to 60%); and CML, 59% (CI, 42% to 76%) compared with 61% (CI, 56% to 66%).
Conclusions: Identical-twin transplants in AML and CML are associated with increased relapse risk compared with HLA-identical sibling transplants. A similar trend was observed in ALL but was not statistically significant. Increased relapse in twin transplants is not explained by lack of graft-versus-host disease. Leukemia-free survival after twin and HLA-identical sibling transplants is similar because increased relapse in twins is offset by decreased treatment-related mortality.
Author and Article Information
From the International Bone Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee, Wisconsin; Salick Health Care, Inc., Los Angeles, California; Methodist Hospital Cancer Center, Indianapolis, Indiana; M.D. Anderson Cancer Center, Houston, Texas; Royal Postgraduate Medical School, London, United Kingdom; Case Western University School of Medicine, Cleveland, Ohio; Huddinge University Hospital, Huddinge, Sweden.
ARTICLE
Identical-Twin Bone Marrow Transplants for Leukemia
Requests for Reprints: Mary M. Horowitz, MD, International Bone Marrow Transplant Registry, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 52226.
Acknowledgments: The authors thank Ms. D'Etta Waldoch Koser and Sharon K. Nell for help with data management and analysis; and Susan J. Hogg, Dottie J. Jacobson, and Linda J. Hoffman for preparation of the manuscript.
Grant Support: In part by Public Health Service grant PO1-CA-40053 from the National Cancer Institute and the National Institute of Allergy and Infectious Diseases of the U.S. Department of Health and Human Services; and grants from Alpha Therapeutic Corporation; Amgen, Inc.; Armour Pharmaceutical Company; Astra Pharmaceutical Products, Inc.; Lynde and Harry Bradley Foundation; Bristol-Myers Oncology; Burroughs-Wellcome Company; Charles E. Culpeper Foundation; Eleanor Naylor Dana Charitable Trust; Eppley Foundation for Research; Hoechst-Roussel Pharmaceuticals; Immunex Corporation; Kettering Family Foundation; Robert J. and Helen C. Kleberg Foundation; Eli Lilly and Company Foundation; Samuel Roberts Noble Foundation; Ortho Biotech Corporation; Elsa U. Pardee Foundation; Jane and Lloyd Pettit Foundation; RGK Foundation; Roche Laboratories; Roerig Division of Pfizer Pharmaceuticals; Sandoz Research Institute; Walter Schroeder Foundation; Stackner Family Foundation; Starr Foundation; Joan and Jack Stein Charities; Swiss Cancer League; and Wyeth-Ayerst Research.
This article has been cited by other articles:
|
|
 |
|
  L. Fouillard, M. Labopin, A. Gratwohl, E. Gluckman, F. Frassoni, D. W. Beelen, R. Willemze, E. Montserrat, D. Blaise, A. I. Atienza, et al. Results of syngeneic hematopoietic stem cell transplantation for acute leukemia: risk factors for outcomes of adults transplanted in first complete remission Haematologica, June 1, 2008; 93(6): 834 - 841. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. C. Matte, J. Cormier, B. E. Anderson, I. Athanasiadis, J. Liu, S. G. Emerson, W. Pear, and W. D. Shlomchik Graft-versus-leukemia in a retrovirally induced murine CML model: mechanisms of T-cell killing Blood, June 1, 2004; 103(11): 4353 - 4361. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. T. Ueno, Y. C. Cheng, G. Rondon, N. M. Tannir, J. L. Gajewski, D. R. Couriel, C. Hosing, M. J. de Lima, P. Anderlini, I. F. Khouri, et al. Rapid induction of complete donor chimerism by the use of a reduced-intensity conditioning regimen composed of fludarabine and melphalan in allogeneic stem cell transplantation for metastatic solid tumors Blood, November 15, 2003; 102(10): 3829 - 3836. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Canitrot, R. Falinski, T. Louat, G. Laurent, C. Cazaux, J.-S. Hoffmann, D. Lautier, and T. Skorski p210 BCR/ABL kinase regulates nucleotide excision repair (NER) and resistance to UV radiation Blood, October 1, 2003; 102(7): 2632 - 2637. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Renga, P. Pedrazzoli, and S. Siena Present results and perspectives of allogeneic non-myeloablative hematopoietic stem cell transplantation for treatment of human solid tumors Ann. Onc., August 1, 2003; 14(8): 1177 - 1184. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Grewal, J. N. Barker, S. M. Davies, and J. E. Wagner Unrelated donor hematopoietic cell transplantation: marrow or umbilical cord blood? Blood, June 1, 2003; 101(11): 4233 - 4244. [Full Text] [PDF]
|
|
|
|
|
|
H. van der Kuip, A. W. Goetz, C. Miething, J. Duyster, and W. E. Aulitzky Adhesion to fibronectin selectively protects Bcr-Abl+ cells from DNA damage-induced apoptosis Blood, September 1, 2001; 98(5): 1532 - 1541. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. F. Storb, R. Champlin, S. R. Riddell, M. Murata, S. Bryant, and E. H. Warren Non-Myeloablative Transplants for Malignant Disease Hematology, January 1, 2001; 2001(1): 375 - 391. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. J. McCarthy and M. R. Bishop Nonmyeloablative Allogeneic Stem Cell Transplantation: Early Promise and Limitations Oncologist, December 1, 2000; 5(6): 487 - 496. [Abstract] [Full Text]
|
|
|
|
|
|
A. J. Barrett, O. Ringden, M.-J. Zhang, A. Bashey, J.-Y. Cahn, M. S. Cairo, R. P. Gale, A. Gratwohl, F. Locatelli, R. Martino, et al. Effect of nucleated marrow cell dose on relapse and survival in identical twin bone marrow transplants for leukemia Blood, June 1, 2000; 95(11): 3323 - 3327. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Bonnet, E. H. Warren, P. D. Greenberg, J. E. Dick, and S. R. Riddell CD8+ minor histocompatibility antigen-specific cytotoxic T lymphocyte clones eliminate human acute myeloid leukemia stem cells PNAS, July 20, 1999; 96(15): 8639 - 8644. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Adkins, R. Brown, L. Goodnough, H. Khoury, J. DiPersio, I. Khouri, and R. Champlin Purine Analog Regimens for Allogeneic Transplant? J. Clin. Oncol., June 1, 1999; 17(6): 1958 - 1960. [Full Text] [PDF]
|
|
|
|
|
|
D. L. Porter, J. M. Connors, V. M.D. Van Deerlin, K. M. Duffy, C. McGarigle, S. L. Saidman, D. G.B. Leonard, and J. H. Antin Graft-Versus-Tumor Induction With Donor Leukocyte Infusions as Primary Therapy for Patients With Malignancies J. Clin. Oncol., April 1, 1999; 17(4): 1234 - 1234. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. M. Smit, M. Rijnbeek, C. A. M. van Bergen, W. E. Fibbe, R. Willemze, and J. H. F. Falkenburg T cells recognizing leukemic CD34+ progenitor cells mediate the antileukemic effect of donor lymphocyte infusions for relapsed chronic myeloid leukemia after allogeneic stem cell transplantation PNAS, August 18, 1998; 95(17): 10152 - 10157. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Giralt, E. Estey, M. Albitar, K. van Besien, G. Rondon, P. Anderlini, S. O'Brien, I. Khouri, J. Gajewski, R. Mehra, et al. Engraftment of Allogeneic Hematopoietic Progenitor Cells With Purine Analog-Containing Chemotherapy: Harnessing Graft-Versus-Leukemia Without Myeloablative Therapy Blood, June 15, 1997; 89(12): 4531 - 4536. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Soiffer, D. Fairclough, M. Robertson, E. Alyea, K. Anderson, A. Freedman, L. Bartlett-Pandite, D. Fisher, R. L. Schlossman, R. Stone, et al. CD6-Depleted Allogeneic Bone Marrow Transplantation for Acute Leukemia in First Complete Remission Blood, April 15, 1997; 89(8): 3039 - 3047. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Choudhury, J. L. Gajewski, J. C. Liang, U. Popat, D. F. Claxton, K.-O. Kliche, M. Andreeff, and R. E. Champlin Use of Leukemic Dendritic Cells for the Generation of Antileukemic Cellular Cytotoxicity Against Philadelphia Chromosome-Positive Chronic Myelogenous Leukemia Blood, February 15, 1997; 89(4): 1133 - 1142. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K Imrie, K. Dicke, and A Keating Autologous bone marrow transplantation for acute myeloid leukemia Stem Cells, January 1, 1996; 14(1): 69 - 78. [Abstract]
|
|
Article
