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Effect of graft source on unrelated donor hemopoietic stem cell transplantation in adults with acute myeloid leukemia after reduced-intensity or nonmyeloablative conditioning: a study from the Société Francaise de Greffe de Moelle et de Thérapie Cellulaire.
Biol Blood Marrow Transplant. 2015 Jun; 21(6):1059-67.BB

Abstract

This retrospective report compared the 4-year outcomes of allogeneic stem cell transplantation (allo-SCT) in 651 adult patients with acute myeloid leukemia receiving a reduced-intensity (RIC) or nonmyeloablative conditioning (NMA) regimen according to the type of unrelated donors. These were either umbilical cord blood (UCB, n = 205), a 9/10 mismatched unrelated donor (MisMUD, n = 99), or a 10/10 matched unrelated donor (MUD, n = 347) graft. Neutrophil recovery was slower in UCB (74.5% by day 42) compared with MisMUD (94.8%) and MUD (95.6%) (P < .001). There was no significant difference in nonrelapse mortality between UCB and both MUD (hazard ratio [HR], 1.05; 95% confidence interval [CI], .62 to 1.78; P = .85) and MisMUD (HR, 1.58; 95% CI, .88 to 2.83; P = .13) The relapse/progression was similar between UCB and MisMUD (HR, .62; 95% CI, .37 to 1.03; P = .07), but was significantly lower in MUD compared with UCB (HR, .60; 95% CI, .39 to .92; P = .02). The rate of extensive chronic graft-versus-host disease (GVHD) was similar between UCB and both MUD (HR, 2.15; 95% CI, .93 to 4.97; P = .08) and MisMUD (HR, 1.84; 95% CI, .68 to 4.95; P = .23). The rate of severe grade III and IV acute GVHD was significantly increased in MisMUD compared with UCB (HR, 2.61; 95% CI, 1.30 to 5.23; P = .007). There was no significant difference in overall survival between UCB and both MisMUD (HR, .98; 95% CI, .66 to 1.45; P = .92) and MUD (HR, .74; 95% CI, .52 to 1.03; P = .08). These data suggest that in the setting of RIC/NMA, allo-SCT UCB is a valid alternative graft source, with significantly less chronic GVHD, compared with MisMUD, when there is no MUD available or when urgent transplantation is needed.

Authors+Show Affiliations

Hematology Department, Nantes Hospital and University Center (CHU), Nantes, France; INSERM UMR 938 and Pierre et Marie Curie University, Paris, France.Hematology and Cell Therapy Department, University Hospital and University of Bordeaux, Bordeaux, France.Blood and Marrow Transplantation Program, Hematology Department, Institut Paoli-Calmettes, Marseille, France.Hematology Department, Nantes Hospital and University Center (CHU), Nantes, France.Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Claude Bernard Lyon EST University, Pierre Bénite, France.Department of Hematology, Hautepierre Hospital, Strasbourg, France.Department of Hematology, Nancy CHU, UTMA, Vandoeuvre-lès-Nancy, France.Hematology Department, Montpellier CHU, Montpellier, France.Department of Hematology, AP-HP, Henri Mondor Hospital, and University Paris-Est-Creteil, Créteil, France.Hematology Department, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France.Bone Marrow Transplantation Unit, Lille CHU, Lille, France.Blood and Marrow Transplantation Unit, Saint-Louis Hospital, AP-HP, Paris, France.INSERM UMR 938 and Pierre et Marie Curie University, Paris, France; Hematology Department, AP-HP, Saint Antoine Hospital, Paris, France. Electronic address: mohamad.mohty@inserm.fr.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25708220

Citation

Malard, Florent, et al. "Effect of Graft Source On Unrelated Donor Hemopoietic Stem Cell Transplantation in Adults With Acute Myeloid Leukemia After Reduced-intensity or Nonmyeloablative Conditioning: a Study From the Société Francaise De Greffe De Moelle Et De Thérapie Cellulaire." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 21, no. 6, 2015, pp. 1059-67.
Malard F, Milpied N, Blaise D, et al. Effect of graft source on unrelated donor hemopoietic stem cell transplantation in adults with acute myeloid leukemia after reduced-intensity or nonmyeloablative conditioning: a study from the Société Francaise de Greffe de Moelle et de Thérapie Cellulaire. Biol Blood Marrow Transplant. 2015;21(6):1059-67.
Malard, F., Milpied, N., Blaise, D., Chevallier, P., Michallet, M., Lioure, B., Clément, L., Hicheri, Y., Cordonnier, C., Huynh, A., Yakoub-Agha, I., Peffault de Latour, R., & Mohty, M. (2015). Effect of graft source on unrelated donor hemopoietic stem cell transplantation in adults with acute myeloid leukemia after reduced-intensity or nonmyeloablative conditioning: a study from the Société Francaise de Greffe de Moelle et de Thérapie Cellulaire. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 21(6), 1059-67. https://doi.org/10.1016/j.bbmt.2015.02.014
Malard F, et al. Effect of Graft Source On Unrelated Donor Hemopoietic Stem Cell Transplantation in Adults With Acute Myeloid Leukemia After Reduced-intensity or Nonmyeloablative Conditioning: a Study From the Société Francaise De Greffe De Moelle Et De Thérapie Cellulaire. Biol Blood Marrow Transplant. 2015;21(6):1059-67. PubMed PMID: 25708220.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of graft source on unrelated donor hemopoietic stem cell transplantation in adults with acute myeloid leukemia after reduced-intensity or nonmyeloablative conditioning: a study from the Société Francaise de Greffe de Moelle et de Thérapie Cellulaire. AU - Malard,Florent, AU - Milpied,Noel, AU - Blaise,Didier, AU - Chevallier,Patrice, AU - Michallet,Mauricette, AU - Lioure,Bruno, AU - Clément,Laurence, AU - Hicheri,Yosr, AU - Cordonnier,Catherine, AU - Huynh,Anne, AU - Yakoub-Agha,Ibrahim, AU - Peffault de Latour,Regis, AU - Mohty,Mohamad, Y1 - 2015/02/20/ PY - 2014/12/30/received PY - 2015/02/14/accepted PY - 2015/2/25/entrez PY - 2015/2/25/pubmed PY - 2016/1/29/medline KW - 10/10 Matched unrelated donor KW - 9/10 Mismatched unrelated donor KW - Acute myeloid leukemia KW - Allogeneic stem cell transplantation KW - Nonmyeloablative conditioning KW - Reduced-intensity conditioning KW - Umbilical cord blood SP - 1059 EP - 67 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol Blood Marrow Transplant VL - 21 IS - 6 N2 - This retrospective report compared the 4-year outcomes of allogeneic stem cell transplantation (allo-SCT) in 651 adult patients with acute myeloid leukemia receiving a reduced-intensity (RIC) or nonmyeloablative conditioning (NMA) regimen according to the type of unrelated donors. These were either umbilical cord blood (UCB, n = 205), a 9/10 mismatched unrelated donor (MisMUD, n = 99), or a 10/10 matched unrelated donor (MUD, n = 347) graft. Neutrophil recovery was slower in UCB (74.5% by day 42) compared with MisMUD (94.8%) and MUD (95.6%) (P < .001). There was no significant difference in nonrelapse mortality between UCB and both MUD (hazard ratio [HR], 1.05; 95% confidence interval [CI], .62 to 1.78; P = .85) and MisMUD (HR, 1.58; 95% CI, .88 to 2.83; P = .13) The relapse/progression was similar between UCB and MisMUD (HR, .62; 95% CI, .37 to 1.03; P = .07), but was significantly lower in MUD compared with UCB (HR, .60; 95% CI, .39 to .92; P = .02). The rate of extensive chronic graft-versus-host disease (GVHD) was similar between UCB and both MUD (HR, 2.15; 95% CI, .93 to 4.97; P = .08) and MisMUD (HR, 1.84; 95% CI, .68 to 4.95; P = .23). The rate of severe grade III and IV acute GVHD was significantly increased in MisMUD compared with UCB (HR, 2.61; 95% CI, 1.30 to 5.23; P = .007). There was no significant difference in overall survival between UCB and both MisMUD (HR, .98; 95% CI, .66 to 1.45; P = .92) and MUD (HR, .74; 95% CI, .52 to 1.03; P = .08). These data suggest that in the setting of RIC/NMA, allo-SCT UCB is a valid alternative graft source, with significantly less chronic GVHD, compared with MisMUD, when there is no MUD available or when urgent transplantation is needed. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/25708220/Effect_of_graft_source_on_unrelated_donor_hemopoietic_stem_cell_transplantation_in_adults_with_acute_myeloid_leukemia_after_reduced_intensity_or_nonmyeloablative_conditioning:_a_study_from_the_Société_Francaise_de_Greffe_de_Moelle_et_de_Thérapie_Cellulaire_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(15)00121-4 DB - PRIME DP - Unbound Medicine ER -