Single Cord Blood Transplantation Versus Unmanipulated Haploidentical Transplantation for Adults with Acute Myeloid Leukemia in Complete Remission

Konuma, Takaaki; Kanda, Junya; Yamasaki, Satoshi; Harada, Kaito; Shimomura, Yoshimitsu; Terakura, Seitaro; Mizuno, Shohei; Uchida, Naoyuki; Tanaka, Masatsugu; Doki, Noriko; Ozawa, Yukiyasu; Nakamae, Hirohisa; Sawa, Masashi; Matsuoka, Ken; Morishige, Satoshi; Maruyama, Yumiko; Ikegame, Kazuhiro; Kimura, Takafumi; Kanda, Yoshinobu; Ichinohe, Tatsuo; Atsuta, Yoshiko; Yanada, Masamitsu

doi:10.1016/j.jtct.2021.01.023

Cited by 30 publications

(19 citation statements)

References 42 publications

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“…This is partly due to improvements of collection and processing techniques of cryopreserved cord blood by cell processing technicians and obstetricians. Moreover, the presence of anti-HLA antibodies, particularly DSA, has mostly been evaluated before selection of a cord blood unit in recent time periods to avoid engraftment failure [ 8 , 34 ]. Indeed, only 56 patients had DSA in the entire our cohort, which was too small population to clarify the impact of presence of DSA on engraftment failure.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…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. For patients still in CR, existing studies demonstrated that similar relapse rates were observed between UCBT and other types of transplantation [ 43 – 45 ]. In our study, all enrolled patients were in CR before transplantation.…”

Section: Discussionmentioning

confidence: 94%

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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“…However, the lack of human leukocyte antigen (HLA)-matched sibling donors (MSDs) restricts the wide use of allo-SCT in the clinic (20)(21)(22). To overcome the deficiency of donors, many efforts have been made to search for alternative donors (4,6,9,(23)(24)(25)(26)(27), including haploidentical donors (HIDs), HLA-matched unrelated donors (MUDs), and umbilical cord blood. Among these alternative donors, haploidentical allografts are the most attractive because successful application of haploidentical transplantation will ensure that almost every allograft candidate has a donor (4,6,9,(24)(25)(26).…”

Section: Introductionmentioning

confidence: 99%

“…To overcome the deficiency of donors, many efforts have been made to search for alternative donors (4,6,9,(23)(24)(25)(26)(27), including haploidentical donors (HIDs), HLA-matched unrelated donors (MUDs), and umbilical cord blood. Among these alternative donors, haploidentical allografts are the most attractive because successful application of haploidentical transplantation will ensure that almost every allograft candidate has a donor (4,6,9,(24)(25)(26). In the 1970s and 1980s, the clinical outcomes after bone marrow transplantation from HLA-mismatched family donors using a conditioning regimen similar to HLA-matched sibling donor transplantation (MSDT) in treating patients with AML were not acceptable because the long-term survival rate was less than 20% (28).…”

Section: Introductionmentioning

confidence: 99%

Haploidentical Stem Cell Transplantation for Acute Myeloid Leukemia: Current Therapies, Challenges and Future Prospective

Chang

Zhao

2021

Front. Oncol.

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Haploidentical stem cell transplantation (haplo-SCT), an alternative donor source, offers a curative therapy for patients with acute myeloid leukemia (AML) who are transplant candidates. Advances in transplantation techniques, such as donor selection, conditioning regimen modification, and graft-versus-host disease prophylaxis, have successfully improved the outcomes of AML patients receiving haplo-SCT and extended the haploidentical transplant indictions for AML. Presently, treating de novo AML, secondary AML, therapy-related AML and refractory and relapsed AML with haplo-SCT can achieve comparable outcomes to those of human leukocyte antigen (HLA)-matched sibling donor transplantation (MSDT), unrelated donor transplantation or umbilical cord blood transplantation. For some subgroups of AML subjects, such as patients with positive pretransplantation minimal/measurable residual disease, recent studies suggest that haplo-SCT might be superior to MSDT in decreasing relapse and improving survival. Unfortunately, for patients with AML after haplo-SCT, relapse and infections remain the causes of death that restrict further improvement in clinical outcomes. In this review, we discuss the recent advances and challenges in haplo-SCT for AML treatment, mainly focusing on unmanipulated haplo-SCT protocols. We provide an outlook on future prospects and suggest that relapse prophylaxis, intervention, and treatment, as well as infection prevention and therapy, are areas of active research in AML patients who receive haploidentical allografts.

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Single Cord Blood Transplantation Versus Unmanipulated Haploidentical Transplantation for Adults with Acute Myeloid Leukemia in Complete Remission

Cited by 30 publications

References 42 publications

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

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

Haploidentical Stem Cell Transplantation for Acute Myeloid Leukemia: Current Therapies, Challenges and Future Prospective

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