In a study (BMT CTN 1702) reported in the Journal of Clinical Oncology, Lee et al found little difference in 2-year survival outcomes between patients considered “very likely” vs “very unlikely” to find an HLA-matched unrelated donor (MUD) for allogeneic hematopoietic cell transplantation as predicted with a donor search prognosis score. As noted by the investigators, “Patients without a MUD may use alternative donors (haploidentical related, mismatched unrelated, or umbilical cord blood).”
Study Details
In the trial, conducted by the Blood and Marrow Transplant Clinical Trials Network (BMT CTN 1702), the primary outcome measure was 2-year overall survival from evaluability for donors among patients very likely (> 90%) vs very unlikely (< 10%) to find a MUD. All other patients were considered “less likely” to find a MUD.
Key Findings
Among a total of 1,751 evaluable patients enrolled at 47 U.S. centers, 54.7% were very likely, 29.5% less likely, and 15.8% very unlikely to identify a MUD.
Unadjusted survival at 2 years was 56% (95% confidence interval [CI] = 50%–62%) in the very unlikely group vs 55% (95% CI = 52%–58%) in the very likely group (hazard ratio [HR] = 1.00, 95% CI = 0.82–1.21, P = .98). In adjusted analysis, there remained no significant difference between the very unlikely group vs the very likely group (HR = 1.07, 95% CI = 0.86–1.33, P = .56).
Among the 1,179 patients who underwent transplantation, MUD was used for 94% of the very likely, 38% of the less likely, and 9% of the very unlikely groups.
On multivariate analysis, there were no significant differences in relapse, treatment-related mortality, disease-free survival, or acute and chronic graft-vs-host diseases among the very likely, less likely, and very unlikely groups following transplantation.
The investigators concluded: “Using a donor search prognosis strategy to prioritize an alternative donor for patients very unlikely to find a MUD resulted in survival and transplant outcomes that were not statistically different compared with those very likely to find a MUD.”
Stephanie J. Lee, MD, MPH, of Fred Hutchinson Cancer Center, Seattle, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by grants from the National Heart, Lung, and Blood Institute, National Cancer Institute, and others. For full disclosures of all study authors, visit ascopubs.org.
