Article

Disease-specific analyses of unrelated cord blood transplantation compared with unrelated bone marrow transplantation in adult patients with acute leukemia

Department of Hematopoietic Stem Cell Transplantation Data Management, Nagoya University School of Medicine, Higashi-ku Nagoya, Japan.
Blood (Impact Factor: 10.43). 02/2009; 113(8):1631-8. DOI: 10.1182/blood-2008-03-147041
Source: PubMed

ABSTRACT We made a disease-specific comparison of unrelated cord blood (CB) recipients and human leukocyte antigen allele-matched unrelated bone marrow (BM) recipients among 484 patients with acute myeloid leukemia (AML; 173 CB and 311 BM) and 336 patients with acute lymphoblastic leukemia (ALL; 114 CB and 222 BM) who received myeloablative transplantations. In multivariate analyses, among AML cases, lower overall survival (hazard ratio [HR]=1.5; 95% confidence interval [CI], 1.0-2.0, P= .028) and leukemia-free survival (HR=1.5; 95% CI, 1.1-2.0, P= .012) were observed in CB recipients. The relapse rate did not differ between the 2 groups of AML (HR=1.2; 95% CI, 0.8-1.9, P= .38); however, the treatment-related mortality rate showed higher trend in CB recipients (HR=1.5; 95% CI, 1.0-2.3, P= .085). In ALL, there was no significant difference between the groups for relapse (HR=1.4, 95% CI, 0.8-2.4, P= .19) and treatment-related mortality (HR=1.0; 95% CI, 0.6-1.7, P= .98), which contributed to similar overall survival (HR=1.1; 95% CI, 0.7-1.6, P= .78) and leukemia-free survival (HR=1.2; 95% CI, 0.9-1.8, P= .28). Matched or mismatched single-unit CB is a favorable alternative stem cell source for patients without a human leukocyte antigen-matched related or unrelated donor. For patients with AML, decreasing mortality, especially in the early phase of transplantation, is required to improve the outcome for CB recipients.

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    • "In Europe and in USA, the most common combination is calcineurin coupled or not with steroids or MMF. However, Japanese transplant centres have shown interesting results with calcineurin combined with low dose MTX (Takahashi et al, 2004, 2007; Atsuta et al 2009). Only prospective studies may establish the role of MTX in GVHD prophylaxis for UCBT. "
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    British Journal of Haematology 10/2009; 147(2):262-74. DOI:10.1111/j.1365-2141.2009.07883.x · 4.96 Impact Factor
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    • "In some (Rocha et al, 2000, 2001; Laughlin et al, 2004; Eapen et al, 2007; Atsuta et al, 2009), but not all (Rocha et al, 2004) registry comparative studies, deaths due to infection accounted for a higher proportion of early deaths among CBT patients as compared to URD patients. Several additional studies reported high rates of early TRM largely due to infection among CBT patients, though low infused cell doses and patient selection biases may have confounded these results (Locatelli et al, 1999; Michel et al, 2003; Arcese et al, 2006). "
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