An Integrative Scoring System for Survival Prediction Following Umbilical Cord Blood Transplantation in Acute Leukemia

Abstract

Purpose: Survival of acute leukemia (AL) patients following umbilical cord blood transplantation (UCBT) is dependent on an array of individual features. Integrative models for risk assessment are lacking. We sought to develop a scoring system for prediction of overall survival (OS) and leukemia-free survival (LFS) at 2 years following UCBT in AL patients.Experimental Design: The study cohort included 3,140 pediatric and adult AL UCBT patients from the European Society of Blood and Marrow Transplantation and Eurocord registries. Patients received single or double cord blood units. The dataset was geographically split into a derivation (n ¼ 2,362, 65%) and validation set (n ¼ 778, 35%). Top predictors of OS were identified using the Random Survival Forest algorithm and introduced into a Cox regression model, which served for the construction of the UCBT risk score. Results:The score includes nine variables: disease status, diagnosis, cell dose, age, center experience, cytomegalovirus serostatus, degree of HLA mismatch, previous autograft, and antithymocyte globulin administration. Over the validation set an increasing score was associated with decreasing probabilities for 2 years OS and LFS, ranging from 70.21% [68.89-70.71 Conclusions: The UCBT score is a simple tool for risk stratification of AL patients undergoing UCBT. Widespread application of the score will require further independent validation. Clin Cancer Res; 23(21); 6478-86. Ó2017 AACR.

Haploidentical transplantation is associated with better overall survival when compared to single cord blood transplantation: an EBMT-Eurocord study of acute leukemia patients conditioned with thiotepa, busulfan, and fludarabine

“…Another important difference is the use of ATG, mainly in patients undergoing SUCBT. Retrospective analyses have found ATG to be associated with worse outcomes after myeloablative and reduced intensity conditioning in the setting of UCBT [42–44]; possibly due to a delayed immune recovery with ATG and increased incidence of post-transplantation lymphoproliferative disorder and infections [43, 45–48]. …”

Individualized prediction of leukemia‐free survival after autologous stem cell transplantation in acute myeloid leukemia

“…[16][17][18]28 In conclusion, age and leukemia risk are predictors of long-term LFS in patients with AML undergoing autografting in CR1. First, it was a retrospective analysis subject to a selection bias because the population was heterogeneous and reported by multiple centers.…”

“…The current nomogram was developed with a rather large cohort of 956 ASCT recipients. 17,18,21,27,28 To get a sense of the characteristics of patients performing well with ASCT, we divided the cohort according to quartiles of predicted LFS probabilities. Even though alternative postremission treatments were not included in the analysis, the population size allowed for an in-depth investigation of outcomes after ASCT.…”

“…Both ASCT and allo-SCT are acceptable options for intermediate molecular risk AML. Several risk scores have been developed in the allo setting [15][16][17][18] but are lacking for ASCT recipients. 1,3,[8][9][10] Furthermore, it is not associated with complications such as graft-versus-host disease, a need for long-term immunosuppression, and reduced quality of life, as seen in allo-SCT recipients.…”

“…1,4 Therefore, tools for evaluating the risk associated with ASCT in AML could help in selecting patients who will gain the most benefit from transplantation. Several risk scores have been developed in the allo setting [15][16][17][18] but are lacking for ASCT recipients. We sought to develop a prognostic model for estimating the probability of leukemia-free survival (LFS) after ASCT in patients with AML in first complete remission (CR1) undergoing transplantation as PRT.…”