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Poor outcome with nonmyeloablative conditioning regimen before cord blood transplantation for patients with high-risk acute myeloid leukemia compared with matched related or unrelated donor transplantation.
Biol Blood Marrow Transplant. 2014 Oct; 20(10):1560-5.BB

Abstract

Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is recommended for patients with high-risk acute myeloid leukemia (AML). In many situations, a matched related (MRD) or matched unrelated donor (MUD) is lacking, in which case unrelated cord blood units (UCB) provide an alternative. We analyzed the outcome of consecutive high-risk AML patients prepared with reduced-intensity conditioning (RIC) regimens and allografted with UCB (n = 32) and compared their outcome with high-risk AML patients who underwent transplantation with MRD/MUD (n = 49) in the same period of time. Grade III to IV acute graft-versus-host disease (GVHD) occurred slightly more frequently in the UCB group (25%) than in the MRD/MUD group (8%) (P = .069). Conversely, we found a lower incidence of extensive chronic GVHD in the UCB group (6%) than in the MRD/MUD group (20%, P = .085). Nonrelapse mortality at 4 years was 16% and 22% in the UCB and MRD/MUD groups, respectively (P = .529). The cumulative incidence of relapse at 4 years was significantly higher in the UCB group (60%) than in the MRD/MUD group (27%, P = .006). Leukemia-free survival (LFS) and overall survival (OS) at 4 years were 25% and 34%, respectively, in the UCB group and 50% and 56%, respectively, in the MRD/MUD group (LFS, P = .029; OS, P = .072). Multivariate analyses adjusted by cytogenetics and disease status at the time of Allo-HSCT revealed that use of UCB remained an independent predictive factor of shorter LFS (hazard ratio, 2.0; 95% confidence interval, 1.1 to 3.6; P = .018), and was associated with a trend for shorter OS (hazard ratio, 1.7; 95% confidence interval, .9 to 3.2; P = .093). Whereas UCB provides an alternative for patients with high-risk AML lacking an MRD/MUD, the high incidence of relapse after RIC-based UCB Allo-HSCT is a concern. Attempts to improve leukemic control with UCB Allo-HSCT are warranted, as well as the evaluation of other alternative donors in this context.

Authors+Show Affiliations

Hematology Department, Transplantation Program, Institut Paoli Calmettes, Marseille, France; Aix-Marseille Université, Marseille, France; Inserm UMR 1068/Centre de Recherche en Cancérologie de Marseille, Marseille, France. Electronic address: devillierr@ipc.unicancer.fr.Hematology Department, Transplantation Program, Institut Paoli Calmettes, Marseille, France; Aix-Marseille Université, Marseille, France.Hematology Department, Transplantation Program, Institut Paoli Calmettes, Marseille, France.Hematology Department, Transplantation Program, Institut Paoli Calmettes, Marseille, France.Hematology Department, Transplantation Program, Institut Paoli Calmettes, Marseille, France.Hematology Department, Transplantation Program, Institut Paoli Calmettes, Marseille, France; Humanitas Cancer Center, Hematology Unit, Instituto Clinico Humanitas, Rozzano, Milano, Italy.Hematology Department, Transplantation Program, Institut Paoli Calmettes, Marseille, France.Cell Therapy Facility, Institut Paoli Calmettes, Marseille, France.Cell Therapy Facility, Institut Paoli Calmettes, Marseille, France.Hematology Department, Transplantation Program, Institut Paoli Calmettes, Marseille, France; Inserm UMR 1068/Centre de Recherche en Cancérologie de Marseille, Marseille, France.Hematology Department, Transplantation Program, Institut Paoli Calmettes, Marseille, France.Hematology Department, Transplantation Program, Institut Paoli Calmettes, Marseille, France.Hematology Department, Transplantation Program, Institut Paoli Calmettes, Marseille, France.Aix-Marseille Université, Marseille, France; Inserm UMR 1068/Centre de Recherche en Cancérologie de Marseille, Marseille, France; Cell Therapy Facility, Institut Paoli Calmettes, Marseille, France.Hematology Department, Transplantation Program, Institut Paoli Calmettes, Marseille, France.Hematology Department, Transplantation Program, Institut Paoli Calmettes, Marseille, France; Aix-Marseille Université, Marseille, France; Inserm UMR 1068/Centre de Recherche en Cancérologie de Marseille, Marseille, France.Hematology Department, Transplantation Program, Institut Paoli Calmettes, Marseille, France; Aix-Marseille Université, Marseille, France; Inserm UMR 1068/Centre de Recherche en Cancérologie de Marseille, Marseille, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24933658

Citation

Devillier, Raynier, et al. "Poor Outcome With Nonmyeloablative Conditioning Regimen Before Cord Blood Transplantation for Patients With High-risk Acute Myeloid Leukemia Compared With Matched Related or Unrelated Donor Transplantation." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 20, no. 10, 2014, pp. 1560-5.
Devillier R, Harbi S, Fürst S, et al. Poor outcome with nonmyeloablative conditioning regimen before cord blood transplantation for patients with high-risk acute myeloid leukemia compared with matched related or unrelated donor transplantation. Biol Blood Marrow Transplant. 2014;20(10):1560-5.
Devillier, R., Harbi, S., Fürst, S., Crocchiolo, R., El-Cheikh, J., Castagna, L., Etienne, A., Calmels, B., Lemarie, C., Prebet, T., Granata, A., Charbonnier, A., Rey, J., Chabannon, C., Faucher, C., Vey, N., & Blaise, D. (2014). Poor outcome with nonmyeloablative conditioning regimen before cord blood transplantation for patients with high-risk acute myeloid leukemia compared with matched related or unrelated donor transplantation. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 20(10), 1560-5. https://doi.org/10.1016/j.bbmt.2014.06.006
Devillier R, et al. Poor Outcome With Nonmyeloablative Conditioning Regimen Before Cord Blood Transplantation for Patients With High-risk Acute Myeloid Leukemia Compared With Matched Related or Unrelated Donor Transplantation. Biol Blood Marrow Transplant. 2014;20(10):1560-5. PubMed PMID: 24933658.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Poor outcome with nonmyeloablative conditioning regimen before cord blood transplantation for patients with high-risk acute myeloid leukemia compared with matched related or unrelated donor transplantation. AU - Devillier,Raynier, AU - Harbi,Samia, AU - Fürst,Sabine, AU - Crocchiolo,Roberto, AU - El-Cheikh,Jean, AU - Castagna,Luca, AU - Etienne,Anne, AU - Calmels,Boris, AU - Lemarie,Claude, AU - Prebet,Thomas, AU - Granata,Angela, AU - Charbonnier,Aude, AU - Rey,Jérôme, AU - Chabannon,Christian, AU - Faucher,Catherine, AU - Vey,Norbert, AU - Blaise,Didier, Y1 - 2014/06/14/ PY - 2014/05/05/received PY - 2014/06/02/accepted PY - 2014/6/17/entrez PY - 2014/6/17/pubmed PY - 2015/5/20/medline KW - Acute myeloid leukemia KW - Allogeneic hematopoietic stem cell transplantation KW - Cord blood transplantation KW - Reduced-intensity conditioning regimen SP - 1560 EP - 5 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol. Blood Marrow Transplant. VL - 20 IS - 10 N2 - Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is recommended for patients with high-risk acute myeloid leukemia (AML). In many situations, a matched related (MRD) or matched unrelated donor (MUD) is lacking, in which case unrelated cord blood units (UCB) provide an alternative. We analyzed the outcome of consecutive high-risk AML patients prepared with reduced-intensity conditioning (RIC) regimens and allografted with UCB (n = 32) and compared their outcome with high-risk AML patients who underwent transplantation with MRD/MUD (n = 49) in the same period of time. Grade III to IV acute graft-versus-host disease (GVHD) occurred slightly more frequently in the UCB group (25%) than in the MRD/MUD group (8%) (P = .069). Conversely, we found a lower incidence of extensive chronic GVHD in the UCB group (6%) than in the MRD/MUD group (20%, P = .085). Nonrelapse mortality at 4 years was 16% and 22% in the UCB and MRD/MUD groups, respectively (P = .529). The cumulative incidence of relapse at 4 years was significantly higher in the UCB group (60%) than in the MRD/MUD group (27%, P = .006). Leukemia-free survival (LFS) and overall survival (OS) at 4 years were 25% and 34%, respectively, in the UCB group and 50% and 56%, respectively, in the MRD/MUD group (LFS, P = .029; OS, P = .072). Multivariate analyses adjusted by cytogenetics and disease status at the time of Allo-HSCT revealed that use of UCB remained an independent predictive factor of shorter LFS (hazard ratio, 2.0; 95% confidence interval, 1.1 to 3.6; P = .018), and was associated with a trend for shorter OS (hazard ratio, 1.7; 95% confidence interval, .9 to 3.2; P = .093). Whereas UCB provides an alternative for patients with high-risk AML lacking an MRD/MUD, the high incidence of relapse after RIC-based UCB Allo-HSCT is a concern. Attempts to improve leukemic control with UCB Allo-HSCT are warranted, as well as the evaluation of other alternative donors in this context. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/24933658/Poor_outcome_with_nonmyeloablative_conditioning_regimen_before_cord_blood_transplantation_for_patients_with_high_risk_acute_myeloid_leukemia_compared_with_matched_related_or_unrelated_donor_transplantation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(14)00353-X DB - PRIME DP - Unbound Medicine ER -