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.

  • Source
    • "The overall survival rate for PID patients undergoing UCBT was comparable to that previously reported for 46 Japanese PID patients undergoing BMT from either HLA-identical siblings or unrelated donors (Sakata et al, 2004), and also to that reported by the European Society of Immunodeficiency and other stem cell transplantation centres for PID patients receiving BMT from HLA-matched related donors, HLA-mismatched related donors or unrelated donors (Antoine et al, 2003; Rao et al, 2005; Dvorak & Cowan, 2008). The time for haematopoietic recovery was comparable to or better than the median recovery time observed in a large cohort of UCBT in children with haematopoietic disorders (Thomson et al, 2000; Michel et al, 2003) and in adults with leukaemia (Laughlin et al, 2004; Atsuta et al, 2009). The incidence of grade 2–4 GVHD (28%) in UCBT was lower compared with that reported in unrelated donor BMT in PID patients in Japan (47%) (Sakata et al, 2004), with that reported in BMT in 90 SCID patients (34%) (Neven et al, 2009) and with that observed in the studies of UCBT for childhood haematological malignancies (Thomson et al, 2000; Michel et al, 2003; Sawczyn et al, 2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: We report the results of umbilical cord blood transplantation (UCBT) performed in 88 patients with primary immunodeficiency (PID) between 1998 and 2008 in Japan; severe combined immunodeficiency (SCID, n = 40), Wiskott-Aldrich syndrome (WAS, n = 23), chronic granulomatous disease (n = 7), severe congenital neutropaenia (SCN, n = 5) and other immunodeficiencies (n = 13). Five-year overall survival (5-year OS) for all patients was 69% [95% confidence interval (CI), 57-78%], and was 71% and 82% for SCID and WAS, respectively. The main cause of death before day 100 was infection (17/19), while that after day 100 was graft-versus-host disease (GVHD) (5/7). Using multivariate analyses, pre-transplant infection, no conditioning, ≥ 2 human leucocyte antigen (HLA) mismatches or diagnosis other than SCID, SCN or WAS were all associated with poor prognosis. Reduced-intensity conditioning was associated with decreased overall mortality compared with myeloablative therapy. The cumulative incidence of grade 2-4 acute GVHD at day 100 was 28% (95% CI, 19-38%), and that of chronic GVHD at day 180 was 13% (95% CI, 7-23%). We conclude that UCBT should be considered for PID patients without an HLA-matched sibling. The control of pre-transplant infection and selection of HLA-matched donors will lead to a better outcome.
    British Journal of Haematology 05/2011; 154(3):363-72. DOI:10.1111/j.1365-2141.2011.08735.x · 4.96 Impact Factor
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The use of unrelated umbilical cord blood (UCB) as an alternative source of haematopoietic stem cells transplantation (HSCT) has been widely used for patients lacking a human leucocyte antigen (HLA) matched donor. One of the disadvantages of using UCB is the limited number of haematopoietic stem cells and, consequently, delayed engraftment and increased risk of early mortality. Many approaches have been investigated in the attempt to improve engraftment and survival. Among those, studies analysing prognostic factors related to patients, disease, donor and transplantation have been performed. Variable factors have been identified, such as factors related to donor choice (HLA, cell dose and others) and transplantation (conditioning and graft-versus-host disease prophylaxis regimens). This review will focus on the interactions between HLA, cell dose and other modifiable factors related to the UCB unit selection and transplantation that may improve outcomes after UCB transplantation.
    British Journal of Haematology 10/2009; 147(2):262-74. DOI:10.1111/j.1365-2141.2009.07883.x · 4.96 Impact Factor
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Growing evidence supports the efficacy of cord blood transplantation (CBT) to treat patients with haematological malignancies, and the number of CBTs is rapidly increasing. Herein, we review considerations regarding conditioning regimens for CBT, the impact of double unit transplantation on CBT outcomes, and data regarding infectious complications following CBT.
    British Journal of Haematology 10/2009; 147(2):207-16. DOI:10.1111/j.1365-2141.2009.07782.x · 4.96 Impact Factor
Show more