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_ DB - PRIME DP - Unbound Medicine ER -