Lack of HLA-matched related/unrelated donor remains a barrier to allogeneic hematopoietic cell transplantation (HCT) for adult acute myeloid leukemia (AML), with ongoing uncertainty about optimal donor type if more than one alternative donor is available. To assess the relationship between donor type, pre-HCT measurable residual disease (MRD), and post-HCT outcomes, we retrospectively analyzed 1265 myelodysplastic neoplasm (MDS)/AML and AML patients allografted in first or second remission with an HLA-matched sibling (MSD) or unrelated donor (MUD), HLA-mismatched unrelated donor (MMD), an HLA-haploidentical donor, or umbilical cord blood (UCB) at a single institution. Relapse risk was non-significantly higher after HLA-haploidentical and lower after UCB HCT. Non-relapse mortality (NRM) was significantly higher in patients undergoing MMD HCT, HLA-haploidentical HCT, and UCB, translating into significantly lower relapse-free survival (RFS) and overall survival for MMD and HLA-haploidentical HCT. There was a significant interaction between conditioning intensity and post-HCT outcomes for UCB HCT with better RFS for UCB HCT after MAC but higher NRM after non-MAC. In patients with pre-HCT MRD receiving MAC, relapse risk was significantly lower and RFS higher in those who underwent UCB HCT in comparison to MSD/MUD. Together, UCB HCT is a valuable alternative for MAC HCT, particularly in patients with pre-HCT MRD.

缺乏 HLA 匹配的相关/无关供体仍然是成人急性髓性白血病 （AML） 同种异体造血细胞移植 （HCT） 的障碍，如果有多个替代供体可用，则最佳供体类型仍然存在不确定性。为了评估供体类型、HCT 前可测量残留病 （MRD） 和 HCT 后结局之间的关系，我们回顾性分析了 1265 例骨髓增生异常肿瘤 （MDS）/AML 和 AML 患者，这些患者与 HLA 匹配的兄弟姐妹 （MSD） 或无关供体 （MUD）、HLA 不匹配的无关供体 （MMD）、HLA 半相合供体或脐带血 （UCB） 在同一个机构。HLA 半相合后复发风险无统计学意义地升高，而 UCB HCT 后复发风险较低。接受 MMD HCT 、 HLA 半相合 HCT 和 UCB 的患者的非复发死亡率 （NRM） 显著较高，转化为 MMD 和 HLA 半相合 HCT 的无复发生存期 （RFS） 和总生存期显著降低。UCB HCT 的调节强度与 HCT 后结局之间存在显着交互作用，MAC 后 UCB HCT 的 RFS 更好，但非 MAC 后 NRM 更高。在接受 MAC 的 HCT 前 MRD 患者中，与 MSD/MUD 相比，接受 UCB HCT 的患者复发风险显著降低，RFS 更高。总之，UCB HCT 是 MAC HCT 的有价值的替代方案，尤其是对于 HCT 前 MRD 患者。