Salvaged single-unit cord blood transplantation for 26 patients with hematologic malignancies not in remission

Yao, Wei; Zheng, Changcheng; Liu, H.L.; Geng, Li; Tang, Baolin; Tong, Juan; Zhu, Xiaoyu; Song, Kaidi; Qiang, Ping; Sun, Zimin

doi:10.1590/1414-431x20154389

Cited by 4 publications

(4 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several studies have reported long‐term survival rates of only 10%‐30% after sibling or unrelated BM or peripheral stem cell transplantation 8‐10 . However, UCBT seems to be more effective, with OS up to 50%‐60% 11,12 . Moreover, in this study, we found that strengthened conditioning regimen with decitabine decreased grade III/IV aGVHD for patients in non‐remission state.…”

Section: Discussionsupporting

confidence: 48%

Decitabine prior to salvaged cord blood transplantation for acute myeloid leukaemia/myelodysplastic syndrome not in remission

et al. 2020

View full text Add to dashboard Cite

What is known and objective Many refractory/relapsed haematological malignancies, in non‐remission state, still have poor prognosis even after allogeneic haematopoietic stem cell transplantation. Recently, decitabine or umbilical cord blood transplantation (UCBT) seemed to be effective in these patients. However, few studies have added decitabine to myeloablative conditioning regimens for UCBT in patients with haematological malignancies not in remission. Therefore, the objective was to evaluate the clinical outcomes of patients with refractory/relapsed acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS) using decitabine as part of a myeloablative conditioning regimen prior to salvaged unrelated UCBT at our centre. Methods We enrolled 20 consecutive patients with refractory/relapsed AML/MDS between 2013 and 2018. All patients were in non‐remission state before transplantation. All transplants were performed with decitabine as part of the myeloablative conditioning regimen, which was decitabine + fludarabine/busulfan/cyclophosphamide. Results and discussion All patients achieved neutrophil and platelet engraftment. Incidence of grade III/IV acute graft‐vs‐host disease (GVHD) was 20.0%, which was also decreased compared to non‐decitabine group (P = .025). The median follow‐up time after UCBT was 29 months (range 14‐64 months). The 2‐year probability of GVHD‐free relapse‐free survival (GRFS) was higher in the decitabine group. Univariate showed that the decitabine group was associated with a higher GRFS than the non‐decitabine group. The estimated probability of overall survival and relapse was 55% and 20.0%, respectively. What is new and conclusions Our results suggest that addition of decitabine as part of the myeloablative conditioning regimen prior to UCBT for refractory/relapsed AML/MDS in patients who are not in remission is safe and might be an effective treatment option.

show abstract

Section: Discussionsupporting

confidence: 48%

Decitabine prior to salvaged cord blood transplantation for acute myeloid leukaemia/myelodysplastic syndrome not in remission

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Clinical studies suggested that unrelated CBT, especially in the setting of a T cell-replete HLA-mismatched graft, might decrease leukemia relapse. Our previous data also suggested that the long-term LFS after CBT could be attributed to the durable allogeneic immune reactions that continue to suppress leukemia progression after transplantation, 3,6,21 especially for primary refractory or relapsed disease 22 because of the fact that high-dose chemotherapy was usually ineffective at prolonging survival. These findings supported the hypothesis that a more potent GvL effect may be achieved after CBT.…”

Section: Discussionmentioning

confidence: 95%

Clinical separation of cGvHD and GvL and better GvHD-free/relapse-free survival (GRFS) after unrelated cord blood transplantation for AML

et al. 2016

Bone Marrow Transplant

View full text Add to dashboard Cite

Few studies have presented a comparison of myeloablative cord blood transplantation (CBT) and HLA-identical sibling hematopoietic cell transplantation (HCT) for AML in a disease-specific analysis, and the evaluation of GvHD-free and relapse-free survival (GRFS) in AML patients after unrelated CBT has not been reported. A total of 162 consecutive AML patients receiving intensified myeloablative unrelated CBT (n = 107) or allogeneic PBSC transplantation (allo-PBSCT) or bone marrow transplantation (BMT) from an HLA-identical sibling donor (n = 55) were investigated. Neutrophil or platelet engraftment was slower in the CBT cohort compared with that in the allo-PBSCT/BMT cohort. The incidence of grade II-IV or grade III-IV acute GvHD (aGvHD) and transplant-related mortality (TRM) were not significantly different in the two cohorts. Compared with the allo-PBSCT/BMT cohort, the CBT cohort had a significantly lower rate of chronic GvHD (cGvHD) (13.7% vs 28.3%; P = 0.047) or extensive cGvHD (9.9% vs 24.1%; hazard ratio (HR) = 2.06, P = 0.039). The incidence of relapse at 5 years in the CBT cohort was significantly lower than that in the allo-PBSCT/BMT cohort (15.3% vs 36.1%; HR = 4.62, P = 0.009). The probabilities of overall survival and leukemia-free survival were similar between the two cohorts. The adjusted 5-year probability of GRFS was higher after CBT than that after allo-PBSCT/BMT (55.4% vs 39.2%; HR = 1.63, P = 0.042). The present study suggests that, for AML patients, intensified myeloablative unrelated CBT is associated with less cGvHD and a lower risk of relapse. In addition, these patients do not experience excessive TRM or severe aGvHD that translates into better GRFS compared with those patients who undergo HLA-identical sibling allo-PBSCT/BMT; this observation may reflect the clinical separation between cGvHD and GvL within our CBT protocol. INTRODUCTIONAllogeneic hematopoietic cell transplantation (allo-HCT) is a promising curative approach for treating high-risk or relapsed/ refractory AML. Unrelated cord blood transplantation (CBT) is increasingly being employed as an alternative transplant strategy for AML patients who lack a related or unrelated donor with an identical HLA type. Cord blood (CB) has some potential advantages, including the absence of donor risk, rapid accessibility and less rigorous requirement for HLA compatibility. Recently, reduced-intensity conditioning followed by CBT has been conducted for high-risk AML patients to decrease the early transplant-related mortality (TRM), 1,2 but the incidence of relapse was high (nearly 50%), and the long-term survival was very poor. New strategies should be further investigated to improve the antileukemic effect after CBT. We have reported that myeloablative CBT can result in improved survival and decreased relapse rates in adult or pediatric recipients with hematologic malignancies 3,4 compared with transplants from HLA-matched sibling donors (MSD); however, few studies have presented a comparative analysis of myeloablative CBT and allo-HCT fro...

show abstract

“…However, few clinical studies have examined pediatric patients with AL who were not in remission and underwent UCBT. Yao et al . reported salvaged single‐unit CBT for 26 patients with hematologic malignancies who were not in remission; her cohort included both adult and pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

Decitabine prior to salvaged unrelated cord blood transplantation for refractory or relapsed childhood acute leukemia

Zhou

Zheng

Zhu

et al. 2016

Pediatric Transplantation

View full text Add to dashboard Cite

No clinical studies have investigated the role of decitabine as a part of the myeloablative conditioning regimen prior to UCBT for refractory or relapsed childhood AL in patients in NR status. The aim of this study was to identify the potential benefits of decitabine as a prior therapy before salvaged unrelated UCBT for refractory or relapsed childhood AL. Eight consecutive patients with childhood refractory/relapsed AL were enrolled in our study between 2013 and 2014. All patients were in NR status before the time of transplant and had features associated with poor outcomes, such as CNSL, MDS-AML, high WBC count at diagnosis, and hypodiploid status (FLT3+/ITD+). Additionally, all patients had one of the following disease statuses: PIF, multiple relapse, or early relapse. All transplants were performed with decitabine as part of the myeloablative conditioning regimen, which was decitabine+Flu/Bu/CY±BCNU or decitabine+Ara-c/BU/CY2±BCNU. A total of seven patients (7 of 8) achieved neutrophil engraftment and platelet engraftment, and one patient experienced primary graft failure. All eight patients (100%) developed PES at a median of 7 days. Three patients developed stage II-IV acute GVHD at a median of 18 days. Additionally, three patients developed chronic GVHD, but it was not extensive in any of those three patients. The median follow-up time after CBT was 19.9 months (range, 9.2-30.7 months). The estimated probability of OS was 75%. Two patients (2 of 8) experienced a testis relapse, and two patients (2 of 8) died. Our experience suggests that the additional application of decitabine as part of the myeloablative conditioning regimen prior to UCBT for refractory or relapsed childhood AL among patients who are not in remission is safe and might be an effective treatment option.

show abstract

Salvaged single-unit cord blood transplantation for 26 patients with hematologic malignancies not in remission

Cited by 4 publications

References 24 publications

Decitabine prior to salvaged cord blood transplantation for acute myeloid leukaemia/myelodysplastic syndrome not in remission

Decitabine prior to salvaged cord blood transplantation for acute myeloid leukaemia/myelodysplastic syndrome not in remission

Clinical separation of cGvHD and GvL and better GvHD-free/relapse-free survival (GRFS) after unrelated cord blood transplantation for AML

Decitabine prior to salvaged unrelated cord blood transplantation for refractory or relapsed childhood acute leukemia

Contact Info

Product

Resources

About