Comparing cord blood transplantation and matched related donor transplantation in non-remission acute myeloid leukemia

Shimomura, Yoshimitsu; Sobue, Tomotaka; Hirabayashi, Shigeki; Kondo, Tadakazu; Mizuno, Shohei; Kanda, Junya; Fujino, Takahiro; Kataoka, Keisuke; Uchida, Naoyuki; Eto, Tetsuya; Miyakoshi, Shigesaburo; Tanaka, Masatsugu; Kawakita, Toshiro; Yokoyama, Hisayuki; Doki, Noriko; Harada, Kaito; Wake, Atsushi; Ota, Shuichi; Takada, Satoru; Takahashi, Satoshi; Kimura, Takafumi; Onizuka, Makoto; Fukuda, Takahiro; Atsuta, Yoshiko; Yanada, Masamitsu

doi:10.1038/s41375-021-01474-0

Cited by 19 publications

(20 citation statements)

References 38 publications

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“…In MRD negative patients the RR was still reduced compared to other cell sources, but this less clearly translated to an improved DFS because of the increased transplant related mortality (TRM) in CB recipients. In a large, retrospective registry study of Japanese adult patients with non-remission AML, RR was reduced in CB SCT recipients compared to matched family donors, and their DFS was better (13). The low incidence of chronic GVHD (14) combined with the GVL effect that CB affords has also resulted in superior chronic GVHD-free relapse-free survival (GFRFS) for CB compared to other donor sources in further studies (15,16).…”

Section: Introductionmentioning

confidence: 99%

T-cell replete cord transplants give superior outcomes in high-risk and relapsed/refractory pediatric myeloid malignancy

et al. 2023

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Stem cell transplant (SCT) outcomes in high-risk (HR) and relapsed/refractory (R/R) paediatric acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) have been poor historically. Cord blood allows T-cell replete transplant (TRCB), enabling enhanced graft-versus-leukaemia. We collected data from 367 consecutive patients undergoing TRCB (112 patients) or other cell source (255 patients) SCT for paediatric AML/MDS in the UK and Ireland between January 2014 and December 2021. Data was collected about patient's demographics, disease and its treatment including previous transplant, measurable residual disease (MRD) status at transplant, HLA-match, relapse, death, graft versus host disease (GvHD) and transplant-related mortality (TRM). Univariable and multivariable analyses were undertaken. There was a higher incidence of poor prognosis features in the TRCB cohort: 51.4% patients were MRD positive at transplant, 46.4% had refractory disease and 21.4% had relapsed after a previous SCT, compared with 26.1%, 8.6% and 5.1% respectively in the comparator group (all p <0.001). Within the TRCB cohort, Event Free Survival (EFS) was 64.1%, 50% in MRD positive patients and 79% in MRD negative (p= 0.009). To allow for the imbalance in baseline characteristics, a multivariable analysis was performed: the TRCB cohort had significantly improved EFS (0.57[0.35-0.91], p=0.019), time to relapse (0.46[0.26-0.81), p=0.008), and reduced chronic GVHD (HR 0.28 [95% CI 0.11-0.70]; p=0.007), with some evidence of improved Overall Survival (OS) (0.65[0.39-1.07], p = 0.088). The effect appeared similar regardless of MRD status, (interaction p-value= 0.29). CB transplant without serotherapy may be the optimal transplant option for children with myeloid malignancy.

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Section: Introductionmentioning

confidence: 99%

T-cell replete cord transplants give superior outcomes in high-risk and relapsed/refractory pediatric myeloid malignancy

et al. 2023

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“…This is because cord blood transplantation (CBT) is acceptable for tolerance to human leukocyte antigen (HLA) mismatch and is rapidly available [ 1 – 3 ]. Indeed, cord blood is an alternative donor source for adult acute myeloid leukemia (AML) patients without a matched related or unrelated donor [ 4 – 9 ]. In Japan, CBT from an unrelated donor has been performed in adults with AML since 1998 [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Improved trends in survival and engraftment after single cord blood transplantation for adult acute myeloid leukemia

et al. 2022

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Unrelated cord blood transplantation (CBT) is an alternative curative option for adult patients with acute myeloid leukemia (AML) who need allogeneic hematopoietic cell transplantation (HCT) but lack an HLA-matched related or unrelated donor. However, large-scale data are lacking on CBT outcomes for unselected adult AML. To investigate the trends of survival and engraftment after CBT over the past 22 years, we retrospectively evaluated the data of patients with AML in Japan according to the time period of CBT (1998–2007 vs 2008–2013 vs 2014–2019). A total of 5504 patients who received single-unit CBT as first allogeneic HCT for AML were included. Overall survival (OS) at 2 years significantly improved over time. The improved OS among patients in ≥ complete remission (CR)3 and active disease at CBT was mainly due to a reduction of relapse-related mortality, whereas among patients in first or second CR at CBT, this was due mainly to a reduction of non-relapse mortality. The trends of neutrophil engraftment also improved over time. This experience demonstrated that the survival and engraftment rate after CBT for this group has improved over the past 22 years.

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“…An enhanced graft-versus-leukemia effect after HLA-mismatched and T-cell-replete UCBT was observed through clinical or experimental data [ 18 , 26 , 39 – 42 ]. However, patients with hematological malignancies enrolled in these studies were either at high risk or in an advanced stage and MRD + , which represented a high disease burden among these cases.…”

Section: Discussionmentioning

confidence: 99%

Unrelated cord blood transplantation vs. HLA-matched sibling transplantation for adults with B-cell acute lymphoblastic leukemia in complete remission: superior OS for patients with long-term survival

et al. 2022

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Background Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an important curative therapy for adult acute lymphoblastic leukemia (ALL). For patients who lack a human leukocyte antigen (HLA)-matched sibling donor, unrelated cord blood (UCB) is an alternative graft option. Previous studies have focused mainly on all T- and B-cell ALL (B-ALL) patients, while data related specifically to adult B-ALL patients after UCB transplantation (UCBT) are scarce. Methods We retrospectively compared the outcomes of UCBT and HLA-matched sibling transplantation (MST) in the treatment of adult B-ALL patients in complete remission (CR) at our center. From June 2006 to December 2020, 156 adult B-ALL patients who achieved CR before transplantation were enrolled. The main clinical outcomes of UCBT and MST were analyzed. Results Hematopoietic recovery was significantly faster in MST recipients than in UCBT recipients. Higher incidences of grades II-IV and III-IV acute graft-versus host disease (aGVHD) were found in UCBT recipients (P < 0.001 and = 0.03), while a lower incidence of extensive chronic GVHD (cGVHD) was found in UCBT recipients (P < 0.001). The cumulative incidences of 2-year non-relapse mortality (NRM), 2-year relapse, 5-year disease-free survival (DFS) and 5-year GVHD-free relapse-free survival (GRFS) were comparable between MST and UCBT recipients. The overall survival (OS) during the first 700 days was similar between the MST and UCBT groups, while the OS of patients with a survival time of more than 700 days in the UCBT group was better than that in the MST group according to multivariate analysis (P = 0.03). Conclusions Our study shows that when treating adult B-ALL patients in CR, UCBT can achieve comparable effects as MST, may provide superior OS for patients with long-term survival, and should be considered a good alternative.

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Comparing cord blood transplantation and matched related donor transplantation in non-remission acute myeloid leukemia

Cited by 19 publications

References 38 publications

T-cell replete cord transplants give superior outcomes in high-risk and relapsed/refractory pediatric myeloid malignancy

T-cell replete cord transplants give superior outcomes in high-risk and relapsed/refractory pediatric myeloid malignancy

Improved trends in survival and engraftment after single cord blood transplantation for adult acute myeloid leukemia

Unrelated cord blood transplantation vs. HLA-matched sibling transplantation for adults with B-cell acute lymphoblastic leukemia in complete remission: superior OS for patients with long-term survival

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