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Reduced-Intensity Allogeneic Transplant for Acute Myeloid Leukemia and Myelodysplastic Syndrome Using Combined CD34-Selected Haploidentical Graft and a Single Umbilical Cord Unit Compared with Matched Unrelated Donor Stem Cells in Older Adults.
Biol Blood Marrow Transplant. 2018 05; 24(5):997-1004.BB

Abstract

Haplo/cord transplantation combines an umbilical cord blood (UCB) graft with CD34-selected haploidentical cells and results in rapid hematopoietic recovery followed by durable UCB engraftment. We compared outcomes of transplants in older patients with acute myeloid leukemia (AML) or high-risk myelodysplastic syndromes (MDS) who received either HLA-matched unrelated donor (MUD) cells or haplo/cord grafts. Between 2007 and 2013, 109 adults ages 50 and older underwent similar reduced-intensity conditioning with fludarabine and melphalan and antibody-mediated T cell depletion for AML (n = 83) or high-risk MDS (n = 26) followed by either a MUD (n = 68) or haplo/cord (n = 41) graft. Patient characteristics were similar for each graft source except for more minority patients receiving a haplo/cord transplant (P = .01). One half of the AML patients were not in remission. Two-year progression-free survival (PFS), overall survival (OS), and graft-versus-host disease-free relapse-free survival were 38%, 48%, and 32.1% for MUD and 33%, 48%, and 33.8% for haplo/cord transplants (P = .62 for PFS; P = .97 for OS; P= .84), respectively. Acute grades II to IV and chronic graft-versus-host-disease rates did not differ at 19.5% and 4.9% in haplo/cord compared with 25% and 7.4% after MUD (P = .53 and P = .62, respectively). Multivariate analysis confirmed no significant differences in transplant outcomes by donor type. Haplo/cord reduced-intensity transplantation achieves similar outcomes relative to MUD in older AML and MDS patients, making this a promising option for those without matched donors.

Authors+Show Affiliations

Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois; Section of Hematology-Oncology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois.Hematopoietic Stem Cell Transplant Program, Weill-Cornell Medical College, New York, New York.Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois.Hematopoietic Stem Cell Transplant Program, Weill-Cornell Medical College, New York, New York.Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois.Department of Pathology, Weill-Cornell Medical College, New York, New York.Hematopoietic Stem Cell Transplant Program, Weill-Cornell Medical College, New York, New York.Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois.Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois.Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois.Hematopoietic Stem Cell Transplant Program, Weill-Cornell Medical College, New York, New York.Section of Hematology-Oncology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois.Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois.Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois.Hematopoietic Stem Cell Transplant Program, Weill-Cornell Medical College, New York, New York.Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois. Electronic address: aartz@medicine.bsd.uchicago.edu.

Pub Type(s)

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

Language

eng

PubMed ID

29288821

Citation

Tsai, Stephanie B., et al. "Reduced-Intensity Allogeneic Transplant for Acute Myeloid Leukemia and Myelodysplastic Syndrome Using Combined CD34-Selected Haploidentical Graft and a Single Umbilical Cord Unit Compared With Matched Unrelated Donor Stem Cells in Older Adults." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 24, no. 5, 2018, pp. 997-1004.
Tsai SB, Rhodes J, Liu H, et al. Reduced-Intensity Allogeneic Transplant for Acute Myeloid Leukemia and Myelodysplastic Syndrome Using Combined CD34-Selected Haploidentical Graft and a Single Umbilical Cord Unit Compared with Matched Unrelated Donor Stem Cells in Older Adults. Biol Blood Marrow Transplant. 2018;24(5):997-1004.
Tsai, S. B., Rhodes, J., Liu, H., Shore, T., Bishop, M., Cushing, M. M., Gergis, U., Godley, L., Kline, J., Larson, R. A., Mayer, S., Odenike, O., Stock, W., Wickrema, A., van Besien, K., & Artz, A. S. (2018). Reduced-Intensity Allogeneic Transplant for Acute Myeloid Leukemia and Myelodysplastic Syndrome Using Combined CD34-Selected Haploidentical Graft and a Single Umbilical Cord Unit Compared with Matched Unrelated Donor Stem Cells in Older Adults. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 24(5), 997-1004. https://doi.org/10.1016/j.bbmt.2017.12.794
Tsai SB, et al. Reduced-Intensity Allogeneic Transplant for Acute Myeloid Leukemia and Myelodysplastic Syndrome Using Combined CD34-Selected Haploidentical Graft and a Single Umbilical Cord Unit Compared With Matched Unrelated Donor Stem Cells in Older Adults. Biol Blood Marrow Transplant. 2018;24(5):997-1004. PubMed PMID: 29288821.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reduced-Intensity Allogeneic Transplant for Acute Myeloid Leukemia and Myelodysplastic Syndrome Using Combined CD34-Selected Haploidentical Graft and a Single Umbilical Cord Unit Compared with Matched Unrelated Donor Stem Cells in Older Adults. AU - Tsai,Stephanie B, AU - Rhodes,Joanna, AU - Liu,Hongtao, AU - Shore,Tsiporah, AU - Bishop,Michael, AU - Cushing,Melissa M, AU - Gergis,Usama, AU - Godley,Lucy, AU - Kline,Justin, AU - Larson,Richard A, AU - Mayer,Sebastian, AU - Odenike,Olatoyosi, AU - Stock,Wendy, AU - Wickrema,Amittha, AU - van Besien,Koen, AU - Artz,Andrew S, Y1 - 2017/12/27/ PY - 2017/05/22/received PY - 2017/12/20/accepted PY - 2017/12/31/pubmed PY - 2019/4/20/medline PY - 2017/12/31/entrez KW - AML KW - Cord blood KW - Elderly KW - MDS KW - Unrelated donor SP - 997 EP - 1004 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol Blood Marrow Transplant VL - 24 IS - 5 N2 - Haplo/cord transplantation combines an umbilical cord blood (UCB) graft with CD34-selected haploidentical cells and results in rapid hematopoietic recovery followed by durable UCB engraftment. We compared outcomes of transplants in older patients with acute myeloid leukemia (AML) or high-risk myelodysplastic syndromes (MDS) who received either HLA-matched unrelated donor (MUD) cells or haplo/cord grafts. Between 2007 and 2013, 109 adults ages 50 and older underwent similar reduced-intensity conditioning with fludarabine and melphalan and antibody-mediated T cell depletion for AML (n = 83) or high-risk MDS (n = 26) followed by either a MUD (n = 68) or haplo/cord (n = 41) graft. Patient characteristics were similar for each graft source except for more minority patients receiving a haplo/cord transplant (P = .01). One half of the AML patients were not in remission. Two-year progression-free survival (PFS), overall survival (OS), and graft-versus-host disease-free relapse-free survival were 38%, 48%, and 32.1% for MUD and 33%, 48%, and 33.8% for haplo/cord transplants (P = .62 for PFS; P = .97 for OS; P= .84), respectively. Acute grades II to IV and chronic graft-versus-host-disease rates did not differ at 19.5% and 4.9% in haplo/cord compared with 25% and 7.4% after MUD (P = .53 and P = .62, respectively). Multivariate analysis confirmed no significant differences in transplant outcomes by donor type. Haplo/cord reduced-intensity transplantation achieves similar outcomes relative to MUD in older AML and MDS patients, making this a promising option for those without matched donors. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/29288821/Reduced_Intensity_Allogeneic_Transplant_for_Acute_Myeloid_Leukemia_and_Myelodysplastic_Syndrome_Using_Combined_CD34_Selected_Haploidentical_Graft_and_a_Single_Umbilical_Cord_Unit_Compared_with_Matched_Unrelated_Donor_Stem_Cells_in_Older_Adults_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(17)31824-4 DB - PRIME DP - Unbound Medicine ER -