Synapse - 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

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:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84943451330&partnerID=40&md5=134388235cd462f1e9cdb31b128adf5a
Notes:	Export Date: 2 November 2015 -- Source: Scopus