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Biol Blood Marrow Transplant. 2015 Mar;21(3):489-95. doi: 10.1016/j.bbmt.2014.11.675. Epub 2014 Dec 19.

Comparison of unrelated cord blood and peripheral blood stem cell transplantation in adults with myelodysplastic syndrome after reduced-intensity conditioning regimen: a collaborative study from Eurocord (Cord blood Committee of Cellular Therapy & Immunobiology Working Party of EBMT) and Chronic Malignancies Working Party.

Author information

1
Hematology-Bone Marrow Transplantation, Saint-Louis Hospital, Paris, France. Electronic address: marie.robin@sls.aphp.fr.
2
Eurocord International Registry, Hôpital Saint-Louis, Paris, France; Service d'hématologie et de Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France.
3
EBMT Office, Hospital Saint Antoine, Universite Pierre et Marie Curie, Paris, France.
4
Division of Hematology and Medical Oncology, University of Leipzig, Leipzig, Germany.
5
Hôpital Haut-Lévêque, Hématologie clinique et thérapie celllulaire, Pessac Cedex, France.
6
Hematology Department, Hospital Universitario La Fe, Valencia, Spain.
7
Hematology, Institut Gustave Roussy, Villejuif, France.
8
EBMT Clinical Trials & Study Office, Leiden, Netherlands.
9
Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
10
Hematology, Institut Paoli Calmettes, Marseille, France.
11
Ludwig-Maximilians University of Munich, Klinikum Großhadern, Medizinische Klinik III, München, Germany.
12
Center for Clinical Hematology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
13
CHU Hematology, Poitiers, France.
14
Service d'hématologie et de Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France; EBMT Acute Leukemia Working Party and Registry, Hospital Saint-Antoine, Paris University, Paris, France.
15
Nottingham University Hospital, Nottingham, United Kingdom.
16
Medical Clinic I, University Hospital, Dresden, Germany.
17
Department of Hematology/Oncology, University Hospital Freiburg, Freiburg, Germany.
18
Eurocord International Registry, Hôpital Saint-Louis, Paris, France.
19
Department of Tumor Immunology, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Molecular Life Sciences, Nijmegen, Netherlands.
20
Center of Oncology-Bone Marrow Transplantation Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Abstract

Hematopoietic stem cell transplantation (HSCT) remains the only curative treatment in patients with higher risk myelodysplastic syndrome (MDS), but the choice of the optimal alternative stem cell source is still a subject of debate in patients lacking an HLA-matched sibling donor. Here, we report on a large series of patients with MDS (N = 631) transplanted either with mobilized peripheral stem cells (PBs) from unrelated donors (n = 502) or with umbilical cord blood transplant (UCB, n = 129) as alternative grafts after reduced-intensity conditioning. Neutrophil engraftment was higher after PB (98% versus 78%, P < .0001). Acute graft-versus-host disease (GVHD) was similar after PB (31%) and UCB (29%), and chronic GVHD incidence was higher after PB (41% versus 23%). Two-year nonrelapse mortality was lower after PB (31% versus 42% P = .03). There was a better overall survival (OS) and disease-free survival (DFS) after PB (49% ± 2% versus 30% ± 4%, P < .0001 and 44% ± 2% versus 28% ± 4%, P < .0001). Multivariate analysis confirmed the advantage of PB for treatment-related mortality, OS, and DFS, whereas relative risk of chronic GVHD was similar. A multivariate analysis comparing PB from a 10/10 HLA-matched donor, PB from a 9/10 HLA-matched donor, and UCB showed an advantage on treatment-related mortality, DFS, and OS only in 10/10 PB. We conclude that in MDS patients lacking an HLA-matched sibling donor, PB from a 10/10 HLA-matched unrelated donor is the preferred source of hematopoietic stem cells. HLA-mismatched unrelated donor or cord blood seem to give similar inferior results except for neutrophil engraftment, which is delayed after UCB.

KEYWORDS:

Alternative donors; Cord blood transplant; Myelodysplastic syndrome; Reduced-intensity conditioning regimen

PMID:
25529382
DOI:
10.1016/j.bbmt.2014.11.675
[Indexed for MEDLINE]
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