Outcomes after Umbilical Cord Blood Transplantation for Myelodysplastic Syndromes

Abstract

For patients with hematologic malignancies undergoing allogeneic hematopoietic cell transplantation, umbilical cord blood transplantation (UCBT) has become an acceptable alternative donor source in the absence of a matched sibling or unrelated donor. However, there have been few published series dedicated solely to describing the outcomes of adult patients with myelodysplastic syndrome (MDS) who have undergone UCBT. From 2004 to 2013, 176 adult MDS patients underwent UCBT as reported to the Center for International Blood and Marrow Transplant Research. Median age at the time of transplant was 56 years (range 18–73 years), with 10% having very low, 23% low, 19% intermediate, 19% high, and 13% very high-risk Revised International Prognostic Scoring System (IPSS-R) scores, respectively. The 100-day probability of Grade 2–4 acute graft-versus-host disease (GVHD) was 38%, and the 3-year probability of chronic GVHD was 28%. The probability of relapse and transplant-related mortality (TRM) at 3 years was 32% and 40%, respectively, leading to a 3-year, disease-free survival (DFS) of 28%, and overall survival (OS) of 31%. In multivariate analysis increasing IPSS-R score at time of HCT was associated with inferior TRM (P=.0056), DFS (P=.018), and OS (P=.0082), but not with GVHD or relapse. Pre-transplant comorbidities were associated with TRM (P=.001), DFS (P=.02), and OS (P=.001). Reduced conditioning intensity was associated with increased risk of relapse (RR 3.95; 95% CI 1.78–8.75, P<.001), and although a higher proportion of myeloablative UCBTs were done for those with high-risk disease, the effect of conditioning regimen intensity was the same regardless of IPSS-R score. For those who lack a matched sibling or unrelated donor, UCBT can result in long-term, disease-free survival for some patients. However, the success of UCBT in this population is hampered by a high rate of TRM.

Graft-versus-MDS effect after unrelated cord blood transplantation: a retrospective analysis of 752 patients registered at the Japanese Data Center for Hematopoietic Cell Transplantation

“…The factors that contributed to OS, such as the age, MDS subtypes and cytogenetic subgroup were almost the same as those reported in previous studies 9,29–34 . However, it is noteworthy that the number of RBC transfusions was extracted as a factor that adversely affected OS.…”

“…The current study revealed that the number of CBT procedures for MDS has been increasing year by year, and that the number of CBT procedures is correlated with an increase in patient age. Graft rejection occurred in approximately 25% of cases, which was higher in comparison to other graft sources 21,22 and previous reports on CBT for hematological maliganancies 9,23 . However, the rate of graft rejection has tended to decrease year by year, and has declined to <15% in 2015.…”

“…One limitation of this study is that the TRUMP database did not include blood cell counts at the time of the diagnosis. Thus, we could not incorporate the IPSS or revised IPSS (IPSS-R) into the analysis 1,9,37 , which would likely be important prognostic factors 30,38 . Although the result of IPSS classifications was collected by the TRUMP, approximately 20% of data were missing; therefore, the MDS subtype was used as a factor contributing to the OS instead of IPSS.…”

“…Umbilical cord blood transplantation (CBT) represents an alternative graft for patients with no HLA-matched siblings or appropriate unrelated donors. Although the number of CBT procedures is increasing year-by-year 8 , the rates of graft failure and relapse of underlying disease in patients who receive CBT are considered to be higher than those of patients who undergo bone marrow transplantation or peripheral blood stem cell transplantation from unrelated donors, and there have been few large-scale studies on CBT for MDS 9,10 . We therefore conducted a retrospective study to examine the outcomes of MDS patients who received CBT using data obtained from the Japanese Data Center for Hematopoietic Cell Transplantation (JDCHCT) database.…”

From patient centered risk factors to comprehensive prognostic models: a suggested framework for outcome prediction in umbilical cord blood transplantation

“…However, the cohort was rather small (n=70) and outdated, since transplantations were performed in the years 2002-2005 (35). Gerds et al, studied outcomes of UCBT in MDS patients (n=176) (44). The HCT-CI was considered as one of the covariates in the analysis.…”