Unrelated cord blood transplantation for adult patients with advanced myelodysplastic syndrome

Ooi, Jun; Iseki, Tohru; Takahashi, Satoshi; Tomonari, Akira; Ishii, K.; Takasugi, Kashiya; Shimohakamada, Yoko; Ohno, Nobuhiro; Uchimaru, Kaoru; Nagamura, Fumitaka; Tojo, Arinobu; Asano, Shigetaka

doi:10.1182/blood-2002-12-3917

Cited by 73 publications

(50 citation statements)

References 17 publications

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“…17,26 Here, we report an International survey of patients who received UCBT for MDS or sAML. DFS was 30%, which appears to be comparable to DFS after HSCT using other types of donors in large multicentric studies in high-risk MDS patients.…”

Section: Discussionmentioning

confidence: 99%

Unrelated cord blood transplantation in adults with myelodysplasia or secondary acute myeloblastic leukemia: a survey on behalf of Eurocord and CLWP of EBMT

et al. 2010

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The aim of our study was to evaluate, through the Eurocord and European Group for Blood and Marrow Transplantation (EBMT) registries, outcomes and risk factors for outcomes in adult patients who underwent single or double unrelated cord blood transplantation (UCBT) for myelodysplastic syndrome (MDS) or secondary acute myeloblastic leukemia (sAML). A total of 180 adults with MDS (n ¼ 39) or sAML (n ¼ 69) were analyzed. Risk factors for outcomes were analyzed using the Fine and Gray method and the Cox model. Median age was 43 (18-72) years. In all, 77 patients (71%) received a single UCBT. Myeloablative conditioning regimen (MAC) was given to 57 (53%) patients. Median numbers of nucleated and CD34 þ cells at freezing were 3.6 Â 10 7 and 1.1 Â 10 5 kg. At 60 days, cumulative incidence of neutrophil recovery was 78±4% and was independently associated with the number of CD34 þ cells per kg (41.1 Â 10 5 ; P ¼ 0.005) and advanced disease status (blasts o5% at time of UCBT, P ¼ 0.016). A 2-year non-relapse mortality (NRM) was significantly higher after MAC (62 vs 34%; P ¼ 0.009). A 2-year disease-free-survival (DFS) and overall survival (OS) were 30 and 34%, respectively. In multivariate analysis, patients with high-risk disease (blasts 45% and International Prognostic scoring system (IPSS) intermediate-2 or high in MDS) had significant poorer DFS (hazard ratio (HR): 1.76; P ¼ 0.047). In spite of high NRM, these data indicate that UCBT is an acceptable alternative option to treat adults with high-risk MDS or sAML, without a suitable human leukocyte antigen (HLA)-matched donor.

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Section: Discussionmentioning

confidence: 99%

Unrelated cord blood transplantation in adults with myelodysplasia or secondary acute myeloblastic leukemia: a survey on behalf of Eurocord and CLWP of EBMT

et al. 2010

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“…6 The Eurocord group reported the results from 16 adult patients with myelodysplastic syndrome who received CBT after myeloablative conditioning. 11 DFS at 2 years was 25%.…”

Section: Myelodysplastic Syndromementioning

confidence: 99%

“…As a result of the early successes with pediatric cord blood transplantation (CBT), cord blood from unrelated donors has been increasingly used as an alternative stem cell source for adult patients with hematological malignancies. [1][2][3][4][5][6][7][8][9][10][11][12][13] Recently several reviews including the clinical results of adult CBT have been published. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] In this review, we focus on recent results of myeloablative CBT in adults.…”

Section: Introductionmentioning

confidence: 99%

Cord blood transplantation in adults

Ooi

2009

Bone Marrow Transplant

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Umbilical cord blood has several advantages of immediate availability, no risk to donors, a lower risk for acute and chronic GVHD despite major human leukocyte Ag (HLA) disparity, and a lower risk of transmitting infections. As a result of the early successes with pediatric cord blood transplantation (CBT), cord blood from unrelated donors have been increasingly used as an alternative stem cell source for adult patients with hematological malignancies. Recent single-institute and registry-based studies suggest that CBT is a safe, feasible and effective strategy for adult patients without suitable related or unrelated BM donors. In this review, we focus on recent results of myeloablative CBT in adults.

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“…A prospective study from Japan using MA UCB for 13 adult patients with advanced MDS showed a 2-year DFS of 76.2%. 75 Three patients relapsed and one patient had engraftment failure. Ten patients are alive with no evidence of disease at days þ 171 to 1558.…”

Section: Umbilical Cord Blood Transplantationmentioning

confidence: 99%

The evolution of hematopoietic SCT in myelodysplastic syndrome

Kindwall‐Keller

Isola

2009

Bone Marrow Transplant

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Allogeneic hematopoietic SCT (allo-HCT) is the only curative therapy for myelodysplastic syndrome (MDS). Numerous myeloablative (MA), nonmyeloablative SCT (NST) and reduced conditioning transplant (RIC) studies have included MDS patients. Twenty-four MA HCT studies published from 2000 and 2008 reported OS and disease-free survival (DFS) ranging from 25 and 16% at 2 years to 52 and 50% at 4 years. In these publications, the incidence of grades II-IV acute GVHD was 18-100%, chronic GVHD 13-88%, relapse risk 24% at 1 year to 54.5% at 4 years and TRM 19% at day 100 to 61% at 5 years. From 2003 to 2008, 30 publications combining RIC and NST reported OS and DFS from 22 and 20% at 2 years to 79 and 79% at 4 years. Incidence of grades II-IV acute GVHD ranged from 9 to 63%, chronic GVHD 18 to 80%, relapse risk 6 to 61% and TRM 0% at day 100 to 34% at 5 years. The wide range in the published results leaves many unanswered questions. Although no ideal transplant conditioning has emerged, many of the MA and RIC studies used BU-based regimens and used a recipient age cutoff of 50-55 years for MA HCT. Similarly, there is no agreement on the use of induction or hypomethylating therapy before HCT, but azacitidine and decitabine are gaining increasing attention as a bridge to HCT. Until recently, the International Prognostic Scoring System (IPSS) dictated the use and timing of HCT. The WHO classification and WHO Prognostic Scoring System (WPSS) may be better suited in predicting the outcomes and should probably be incorporated in transplant algorithms. Most published MDS transplant series combine matched related donors (MRD) and matched unrelated donors (MUD). Umbilical cord blood (UCB) grafts will likely broaden the population of MDS patients eligible for allografting, but outcome data for MDS are scant. At this time, it is reasonable to consider the availability of an MRD or MUD as separate from an UCB graft in the decision of transplantation for MDS. The development of RIC, improvements in supportive therapy and alternative donor selection will provide better OS for MDS patients undergoing transplantation. Simultaneously, better understanding and medical therapy of MDS are leading us to re-examine patient selection and the timing of HCT. The results of HCT for MDS continue to improve together with the outlook of patients afflicted with myelodysplasia.

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Unrelated cord blood transplantation for adult patients with advanced myelodysplastic syndrome

Cited by 73 publications

References 17 publications

Unrelated cord blood transplantation in adults with myelodysplasia or secondary acute myeloblastic leukemia: a survey on behalf of Eurocord and CLWP of EBMT

Unrelated cord blood transplantation in adults with myelodysplasia or secondary acute myeloblastic leukemia: a survey on behalf of Eurocord and CLWP of EBMT

Cord blood transplantation in adults

The evolution of hematopoietic SCT in myelodysplastic syndrome

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