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Outcomes of UCB transplantation are comparable in FLT3+ AML: results of CIBMTR, EUROCORD and EBMT collaborative analysis.
Leukemia. 2017 06; 31(6):1408-1414.L

Abstract

Allogeneic hematopoietic cell transplantation (HCT) from siblings or unrelated donors (URD) during complete remission (CR) may improve leukemia-free survival (LFS) in FMS-like tyrosine kinase 3+ (FLT3+) acute myeloid leukemia (AML), which has poor prognosis because of high relapse rates. Umbilical cord blood (UCB) HCT outcomes are largely unknown in this population. We found that compared with sibling HCT, relapse risks were similar after UCB (n=126) (hazard ratio (HR) 0.86, P=0.54) and URD (n=91) (HR 0.81, P=0.43). UCB HCT was associated with statistically higher non-relapse mortality compared with sibling HCT (HR 2.32, P=0.02), but not vs URD (HR 1.72, P=0.07). All three cohorts had statistically nonsignificant 3-year LFS: 39% (95% confidence interval (CI): 30-47) after UCB, 43% (95% CI: 30-54) after sibling and 50% (95% CI: 40-60) after URD. Chronic graft-versus-host disease rates were significantly lower after UCB compared with either sibling (HR 0.59, P=0.03) or URD (HR 0.49, P=0.001). Adverse factors for LFS included high leukocyte count at diagnosis and HCT during CR2 (second CR). UCB is a suitable option for adults with FLT3+ AML in the absence of an human leukocyte antigen-matched sibling and its immediate availability may be particularly important for FLT3+ AML where early relapse is common, thus allowing HCT in CR1 (first CR) when outcomes are best.

Authors+Show Affiliations

Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA.Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France. Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France.CIBMTR (Center for International Blood and Marrow Transplantation), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.CIBMTR (Center for International Blood and Marrow Transplantation), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.University of Minnesota Medical Center Fairview, Minneapolis, MN, USA.European Group for Blood and Marrow Transplantation, Leiden, The Netherlands. Sorbonne Universites, Centre de Recherche (CDR), Saint Antoine, Paris, France.Churchill Hospital, Oxford, UK.Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA.Centre Hospitalier Universitaire de LiFge, Domaine Universityaire du Sart Tilman, Leige, Belgium.Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.CIBMTR (Center for International Blood and Marrow Transplantation), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France. Monacord, Centre Scientifique de Monaco, Monaco.The Bone Marrow Transplantation Department, Division of Internal Medicine, The Chaim Sheba Medical Center, Ramat-Gan, Israel. Sheba Cord Blood Bank, Rama-Gan, Israel.Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA.Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France. Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

28119528

Citation

Ustun, C, et al. "Outcomes of UCB Transplantation Are Comparable in FLT3+ AML: Results of CIBMTR, EUROCORD and EBMT Collaborative Analysis." Leukemia, vol. 31, no. 6, 2017, pp. 1408-1414.
Ustun C, Giannotti F, Zhang MJ, et al. Outcomes of UCB transplantation are comparable in FLT3+ AML: results of CIBMTR, EUROCORD and EBMT collaborative analysis. Leukemia. 2017;31(6):1408-1414.
Ustun, C., Giannotti, F., Zhang, M. J., Wang, H. L., Brunstein, C., Labopin, M., Rocha, V., de Lima, M., Baron, F., Sandmaier, B. M., Eapen, M., Gluckman, E., Nagler, A., Weisdorf, D. J., & Ruggeri, A. (2017). Outcomes of UCB transplantation are comparable in FLT3+ AML: results of CIBMTR, EUROCORD and EBMT collaborative analysis. Leukemia, 31(6), 1408-1414. https://doi.org/10.1038/leu.2017.42
Ustun C, et al. Outcomes of UCB Transplantation Are Comparable in FLT3+ AML: Results of CIBMTR, EUROCORD and EBMT Collaborative Analysis. Leukemia. 2017;31(6):1408-1414. PubMed PMID: 28119528.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes of UCB transplantation are comparable in FLT3+ AML: results of CIBMTR, EUROCORD and EBMT collaborative analysis. AU - Ustun,C, AU - Giannotti,F, AU - Zhang,M-J, AU - Wang,H-L, AU - Brunstein,C, AU - Labopin,M, AU - Rocha,V, AU - de Lima,M, AU - Baron,F, AU - Sandmaier,B M, AU - Eapen,M, AU - Gluckman,E, AU - Nagler,A, AU - Weisdorf,D J, AU - Ruggeri,A, Y1 - 2017/01/25/ PY - 2016/09/08/received PY - 2016/12/11/revised PY - 2016/12/21/accepted PY - 2017/1/26/pubmed PY - 2017/10/19/medline PY - 2017/1/26/entrez SP - 1408 EP - 1414 JF - Leukemia JO - Leukemia VL - 31 IS - 6 N2 - Allogeneic hematopoietic cell transplantation (HCT) from siblings or unrelated donors (URD) during complete remission (CR) may improve leukemia-free survival (LFS) in FMS-like tyrosine kinase 3+ (FLT3+) acute myeloid leukemia (AML), which has poor prognosis because of high relapse rates. Umbilical cord blood (UCB) HCT outcomes are largely unknown in this population. We found that compared with sibling HCT, relapse risks were similar after UCB (n=126) (hazard ratio (HR) 0.86, P=0.54) and URD (n=91) (HR 0.81, P=0.43). UCB HCT was associated with statistically higher non-relapse mortality compared with sibling HCT (HR 2.32, P=0.02), but not vs URD (HR 1.72, P=0.07). All three cohorts had statistically nonsignificant 3-year LFS: 39% (95% confidence interval (CI): 30-47) after UCB, 43% (95% CI: 30-54) after sibling and 50% (95% CI: 40-60) after URD. Chronic graft-versus-host disease rates were significantly lower after UCB compared with either sibling (HR 0.59, P=0.03) or URD (HR 0.49, P=0.001). Adverse factors for LFS included high leukocyte count at diagnosis and HCT during CR2 (second CR). UCB is a suitable option for adults with FLT3+ AML in the absence of an human leukocyte antigen-matched sibling and its immediate availability may be particularly important for FLT3+ AML where early relapse is common, thus allowing HCT in CR1 (first CR) when outcomes are best. SN - 1476-5551 UR - https://www.unboundmedicine.com/medline/citation/28119528/Outcomes_of_UCB_transplantation_are_comparable_in_FLT3+_AML:_results_of_CIBMTR_EUROCORD_and_EBMT_collaborative_analysis_ L2 - https://doi.org/10.1038/leu.2017.42 DB - PRIME DP - Unbound Medicine ER -