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Comparison of outcomes after two standards-of-care reduced-intensity conditioning regimens and two different graft sources for allogeneic stem cell transplantation in adults with hematologic diseases: a single-center analysis.
Biol Blood Marrow Transplant. 2013 Jun; 19(6):934-9.BB

Abstract

Recent advances in allogeneic stem cell transplantation (allo-HSCT) have included the advent of reduced-intensity conditioning (RIC) regimens to decrease the toxicity of myeloablative allo-SCT and the use of double umbilical cord blood (dUCB) units as a graft source in adults lacking a suitable donor. The FB2A2 regimen (fludarabine 30 mg/kg/day for 5-6 days + i.v. busulfan 3.6 mg/kg/day for 2 days + rabbit antithymocyte globulin 2.5 mg/kg/day for 2 days) supported by peripheral blood stem cells (PBSCs) and the TCF regimen (fludarabine 200 mg/m² for 5 days + cyclophosphamide 50 mg/kg for 1 day + low-dose [2 Gy] total body irradiation) supported by dUCB units are currently the most widely used RIC regimens in many centers and could be considered standard of care in adults eligible for an RIC allo-SCT. Here we compared, retrospectively, the outcomes of adults patients who received the FB2A2-PBSC RIC regimen (n = 52; median age, 59 years; median follow-up, 19 months) and those who received the dUCB-TCF RIC regimen (n = 39; median age, 56 years; median follow-up, 20 months) for allo-SCT between January 2007 and November 2010. There were no significant between-group differences in patient and disease characteristics. Cumulative incidences of engraftment, acute grade II-IV and chronic graft-versus-host disease were similar in the 2 groups. The median time to platelet recovery, incidence of early death (before day +100), and 2-year nonrelapse mortality were significantly higher in the dUCB-TCF group (38 days versus 0 days [P <.0001]; 20.5% versus 4% [P = .05], and 26.5% versus 6% [P = .02], respectively). The groups did not differ in terms of 2-year overall survival (62% for FB2A2-PBSC versus 61% for dUCB-TCF), disease-free survival (59% versus 50.5%), or relapse incidence (35.5% versus 23%). In multivariate analysis, the presence of a lymphoid disorder was associated with a significantly higher 2-year overall survival (hazard ratio, 0.42; 95% confidence interval, 0.20-0.87; P = .02), whereas patients receiving a FB2A2-PBSC allo-SCT had a significantly lower 2-year nonrelapse mortality (hazard ratio, 0.24; 95% confidence interval, 0.1-0.7; P = .01). There were no factors associated with higher 2-year disease-free survival or lower relapse incidence. This study suggests that the dUCB-TCF regimen provides a valid alternative in adults lacking a suitable donor and eligible for RIC allo-SCT. Prospective and randomized studies are warranted to establish the definitive role of dUCB RIC allo-SCT in adults. In addition, strategies for decreasing nonrelapse mortality after dUCB RIC allo-SCT are urgently needed.

Authors+Show Affiliations

Department and CIC, CHU Hotel Dieu, Nantes, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23523970

Citation

Le Bourgeois, Amandine, et al. "Comparison of Outcomes After Two Standards-of-care Reduced-intensity Conditioning Regimens and Two Different Graft Sources for Allogeneic Stem Cell Transplantation in Adults With Hematologic Diseases: a Single-center Analysis." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 19, no. 6, 2013, pp. 934-9.
Le Bourgeois A, Mohr C, Guillaume T, et al. Comparison of outcomes after two standards-of-care reduced-intensity conditioning regimens and two different graft sources for allogeneic stem cell transplantation in adults with hematologic diseases: a single-center analysis. Biol Blood Marrow Transplant. 2013;19(6):934-9.
Le Bourgeois, A., Mohr, C., Guillaume, T., Delaunay, J., Malard, F., Loirat, M., Peterlin, P., Blin, N., Dubruille, V., Mahe, B., Gastinne, T., Le Gouill, S., Moreau, P., Mohty, M., Planche, L., Lode, L., Bene, M. C., & Chevallier, P. (2013). Comparison of outcomes after two standards-of-care reduced-intensity conditioning regimens and two different graft sources for allogeneic stem cell transplantation in adults with hematologic diseases: a single-center analysis. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 19(6), 934-9. https://doi.org/10.1016/j.bbmt.2013.03.009
Le Bourgeois A, et al. Comparison of Outcomes After Two Standards-of-care Reduced-intensity Conditioning Regimens and Two Different Graft Sources for Allogeneic Stem Cell Transplantation in Adults With Hematologic Diseases: a Single-center Analysis. Biol Blood Marrow Transplant. 2013;19(6):934-9. PubMed PMID: 23523970.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of outcomes after two standards-of-care reduced-intensity conditioning regimens and two different graft sources for allogeneic stem cell transplantation in adults with hematologic diseases: a single-center analysis. AU - Le Bourgeois,Amandine, AU - Mohr,Catherine, AU - Guillaume,Thierry, AU - Delaunay,Jacques, AU - Malard,Florent, AU - Loirat,Marion, AU - Peterlin,Pierre, AU - Blin,Nicolas, AU - Dubruille,Viviane, AU - Mahe,Beatrice, AU - Gastinne,Thomas, AU - Le Gouill,Steven, AU - Moreau,Philippe, AU - Mohty,Mohamad, AU - Planche,Lucie, AU - Lode,Laurence, AU - Bene,Marie-Christine, AU - Chevallier,Patrice, Y1 - 2013/03/21/ PY - 2013/01/11/received PY - 2013/03/18/accepted PY - 2013/3/26/entrez PY - 2013/3/26/pubmed PY - 2013/12/16/medline SP - 934 EP - 9 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol Blood Marrow Transplant VL - 19 IS - 6 N2 - Recent advances in allogeneic stem cell transplantation (allo-HSCT) have included the advent of reduced-intensity conditioning (RIC) regimens to decrease the toxicity of myeloablative allo-SCT and the use of double umbilical cord blood (dUCB) units as a graft source in adults lacking a suitable donor. The FB2A2 regimen (fludarabine 30 mg/kg/day for 5-6 days + i.v. busulfan 3.6 mg/kg/day for 2 days + rabbit antithymocyte globulin 2.5 mg/kg/day for 2 days) supported by peripheral blood stem cells (PBSCs) and the TCF regimen (fludarabine 200 mg/m² for 5 days + cyclophosphamide 50 mg/kg for 1 day + low-dose [2 Gy] total body irradiation) supported by dUCB units are currently the most widely used RIC regimens in many centers and could be considered standard of care in adults eligible for an RIC allo-SCT. Here we compared, retrospectively, the outcomes of adults patients who received the FB2A2-PBSC RIC regimen (n = 52; median age, 59 years; median follow-up, 19 months) and those who received the dUCB-TCF RIC regimen (n = 39; median age, 56 years; median follow-up, 20 months) for allo-SCT between January 2007 and November 2010. There were no significant between-group differences in patient and disease characteristics. Cumulative incidences of engraftment, acute grade II-IV and chronic graft-versus-host disease were similar in the 2 groups. The median time to platelet recovery, incidence of early death (before day +100), and 2-year nonrelapse mortality were significantly higher in the dUCB-TCF group (38 days versus 0 days [P <.0001]; 20.5% versus 4% [P = .05], and 26.5% versus 6% [P = .02], respectively). The groups did not differ in terms of 2-year overall survival (62% for FB2A2-PBSC versus 61% for dUCB-TCF), disease-free survival (59% versus 50.5%), or relapse incidence (35.5% versus 23%). In multivariate analysis, the presence of a lymphoid disorder was associated with a significantly higher 2-year overall survival (hazard ratio, 0.42; 95% confidence interval, 0.20-0.87; P = .02), whereas patients receiving a FB2A2-PBSC allo-SCT had a significantly lower 2-year nonrelapse mortality (hazard ratio, 0.24; 95% confidence interval, 0.1-0.7; P = .01). There were no factors associated with higher 2-year disease-free survival or lower relapse incidence. This study suggests that the dUCB-TCF regimen provides a valid alternative in adults lacking a suitable donor and eligible for RIC allo-SCT. Prospective and randomized studies are warranted to establish the definitive role of dUCB RIC allo-SCT in adults. In addition, strategies for decreasing nonrelapse mortality after dUCB RIC allo-SCT are urgently needed. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/23523970/Comparison_of_outcomes_after_two_standards_of_care_reduced_intensity_conditioning_regimens_and_two_different_graft_sources_for_allogeneic_stem_cell_transplantation_in_adults_with_hematologic_diseases:_a_single_center_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(13)00125-0 DB - PRIME DP - Unbound Medicine ER -