High disease-free survival with enhanced protection against relapse after double-unit cord blood transplantation when compared with T cell-depleted unrelated donor transplantation in patients with acute leukemia and chronic myelogenous leukemia Journal Article


Authors: Ponce, D. M.; Hilden, P.; Devlin, S. M.; Maloy, M.; Lubin, M.; Castro-Malaspina, H.; Dahi, P.; Hsu, K.; Jakubowski, A. A.; Kernan, N. A.; Koehne, G.; O'Reilly, R. J.; Papadopoulos, E. B.; Perales, M. A.; Sauter, C.; Scaradavou, A.; Tamari, R.; van den Brink, M. R. M.; Young, J. W.; Giralt, S.; Barker, J. N.
Article Title: High disease-free survival with enhanced protection against relapse after double-unit cord blood transplantation when compared with T cell-depleted unrelated donor transplantation in patients with acute leukemia and chronic myelogenous leukemia
Abstract: Double-unit cord blood (DCB) grafts are a rapidly available stem cell source for adults with high-risk leukemias. However, how disease-free survival (DFS) after DCB transplantation (DCBT) compares to that of unrelated donor transplantation (URDT) is not fully established. We analyzed 166 allograft recipients (66 8/8 HLA-matched URDT, 45 7/8 HLA-matched URDT, and 55 DCBT) ages 16 to 60 years with high-risk acute leukemia or chronic myelogenous leukemia (CML). URDT and DCBT recipients were similar except DCBT recipients were more likely to have lower weight and non-European ancestry and to receive intermediate-intensity conditioning. All URDT recipients received a CD34+ cell-selected (T cell-depleted) graft. Overall, differences between the 3-year transplantation-related mortality were not significant (8/8 URDT, 18%; 7/8 URDT, 39%; and DCBT, 24%; P = .108), whereas the 3-year relapse risk was decreased after DCBT (8/8 URDT, 23%; 7/8 URDT, 20%; and DCBT 9%, P = .037). Three-year DFS was 57% in 8/8 URDT, 41% in 7/8 URDT, and 68% in DCBT recipients (P = .068), and the 3-year DFS in DCBT recipients was higher than that of 7/8 URDT recipients (P = .021). In multivariate analysis in acute leukemia patients, factors adversely associated with DFS were female gender (hazard ratio [HR], 1.68; P = .031), diagnosis of acute lymphoblastic leukemia (HR, 2.09; P = .004), and 7/8 T cell-depleted URDT (HR, 1.91; P = .037). High DFS can be achieved in adults with acute leukemia and CML with low relapse rates after DCBT. Our findings support performing DCBT in adults in preference to HLA-mismatched T cell-depleted URDT and suggest DCBT is a readily available alternative to T cell-depleted 8/8 URDT, especially in patients requiring urgent transplantation. © 2015 American Society for Blood and Marrow Transplantation.
Keywords: adolescent; adult; major clinical study; overall survival; busulfan; fludarabine; mortality; cancer patient; disease free survival; drug megadose; cd34 antigen; cyclophosphamide; melphalan; chronic myeloid leukemia; thiotepa; acute lymphoblastic leukemia; high risk patient; acute leukemia; cord blood stem cell transplantation; hla matching; acute myeloblastic leukemia; intermethod comparison; t cell depletion; gender; unrelated donor transplantation; leukemia relapse; graft recipient; clofarabine; thymocyte antibody; acute biphenotypic leukemia; unrelated donors; cord blood transplantation; hla match; human; male; female; article
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 21
Issue: 11
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2015-11-01
Start Page: 1985
End Page: 1993
Language: English
DOI: 10.1016/j.bbmt.2015.07.029
PROVIDER: scopus
PUBMED: 26238810
PMCID: PMC4768474
DOI/URL:
Notes: Export Date: 2 November 2015 -- Source: Scopus
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MSK Authors
  1. Nancy Kernan
    512 Kernan
  2. Sergio Andres Giralt
    1053 Giralt
  3. Craig Steven Sauter
    334 Sauter
  4. Doris Ponce
    256 Ponce
  5. Miguel-Angel Perales
    915 Perales
  6. Katharine C Hsu
    184 Hsu
  7. Juliet N Barker
    335 Barker
  8. Guenther Koehne
    194 Koehne
  9. James W Young
    319 Young
  10. Richard O'Reilly
    748 O'Reilly
  11. Marissa N Lubin
    79 Lubin
  12. Molly Anna Maloy
    269 Maloy
  13. Sean McCarthy Devlin
    601 Devlin
  14. Parastoo Bahrami Dahi
    295 Dahi
  15. Roni Tamari
    210 Tamari
  16. Patrick Dale Hilden
    108 Hilden