Donor age and degree of HLA matching have a major impact on the outcome of unrelated donor haematopoietic cell transplantation for chronic myeloid leukaemia

We analysed the outcome of 92 consecutive unrelated donor haematopoietic cell transplantations (UD-HCTs) performed in Spain to treat adult patients with CML in the first chronic phase (1CP). Patients' and donors' median age was 32 (15-49) and 36 (22-56) years, respectively. In all, 73 pairs (79%) matched for A, B +/- C and DRB1 +/- DQB1 loci and 19 had >= 1 mismatch. Their probability of survival and disease-free survival at 4 years were 50 and 46%, respectively. Pretransplant factors associated with a better survival were patient age < 25 years (P = 0.035), donor age <= 36 years (P = 0.012), use of cyclosporine since day -7 (P = 0.001), and matching 8/8, 9/10 or 10/10 loci at allele level (P = 0.003). In multivariate analysis only donor age (P = 0.003; RR = 3.1 (95% CI: 1.3-7.1)) and degree of HLA-matching (P = 0.009; RR: 7.7 (95% CI: 1.8-33)) maintained their significance. The addition of these two variables to the EBMT prognostic score allowed an adequate risk assessment for patients receiving a UD-HCT during 1CP. Our analysis shows that in patients with a young and fully allele-matched donor, UD-HCT should be considered in the initial therapeutic algorithm due to its excellent outcome (92% survival at 2 years).