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Identical-twin bone marrow transplants for leukemia

R P Gale1, M M Horowitz, R C Ash

  • 1International Bone Marrow Transplant Registry, Medical College of Wisconsin, Milwaukee.

Annals of Internal Medicine
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Identical-twin bone marrow transplants for leukemia show higher relapse rates in AML and CML compared to sibling transplants. However, overall leukemia-free survival remains similar due to reduced treatment-related mortality in twins.

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Area of Science:

  • Hematology
  • Oncology
  • Transplantation Immunology

Background:

  • Bone marrow transplantation is a critical treatment for various leukemias.
  • Comparing outcomes between identical-twin and HLA-identical sibling allogeneic transplants is essential for optimizing donor selection.
  • Graft-versus-host disease (GVHD) is a significant factor influencing transplant success.

Purpose of the Study:

  • To compare the outcomes of leukemia treatment using identical-twin versus HLA-identical sibling bone marrow transplants.
  • To analyze differences in relapse rates, treatment-related mortality, and leukemia-free survival between these two donor types.
  • To investigate the role of GVHD in observed outcome differences.

Main Methods:

  • A matched-pair analysis was conducted using data from the International Bone Marrow Transplant Registry (1978-1990).
  • Cohorts of identical-twin transplants (n=103) were compared with matched HLA-identical sibling transplants (n=1030) for acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML), and chronic myelogenous leukemia (CML).
  • Outcomes including relapse, treatment-related mortality, and leukemia-free survival were assessed, with and without adjustment for GVHD.

Main Results:

  • Identical-twin transplants were associated with significantly higher relapse rates in AML (52% vs. 16%) and CML (40% vs. 7%) compared to HLA-identical sibling transplants. A similar trend was observed in ALL (36% vs. 26%).
  • Increased relapse risks in AML and CML persisted after adjusting for GVHD.
  • Despite higher relapse rates, identical-twin transplants showed lower treatment-related mortality, resulting in similar three-year leukemia-free survival rates across all leukemia types (ALL: 57% vs. 58%; AML: 42% vs. 55%; CML: 59% vs. 61%).

Conclusions:

  • Identical-twin bone marrow transplants for AML and CML are linked to an increased risk of relapse compared to HLA-identical sibling transplants.
  • The higher relapse rate in twin transplants is not attributable to a lack of GVHD.
  • The similar leukemia-free survival observed between twin and sibling transplants is a result of the trade-off between increased relapse and decreased treatment-related mortality in twin recipients.