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Leukemia. 2015 Sep;29(9):1891-900. doi: 10.1038/leu.2015.98. Epub 2015 Apr 17.

Comparison of outcomes after unrelated cord blood and unmanipulated haploidentical stem cell transplantation in adults with acute leukemia.

Author information

1
Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, AP-HP, Paris, France.
2
INSERM, UMRs 938, Paris, France.
3
Hôpital Saint Louis, Eurocord, IUH University Paris VII, Paris, France.
4
Hôpital Saint Antoine, Université Pierre and Marie Curie, Paris, France.
5
Hospital Universitario y Politécnico La Fe, Valencia, Spain.
6
Hematology and BMT Unit, San Raffaele Scientific Institute, Milano, Italy.
7
Rome Transplant Network, University Tor Vergata, Rome, Italy.
8
Dipartimento di Ematologia, Ospedale San Martino, Genova, Italy.
9
Institut Paoli Calmettes, Marseille, France.
10
Careggi University Hospital, Firenze, Italy.
11
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
12
Evangelismos Hospital, Division of Hematology, BMT Unit, Athens, Greece.
13
Stem Cell Transplant Unit, Medical Park, Antalya, Turkey.
14
Hôpital Edouard Herriot, Lyon, France.
15
Ospedale Civile, Dipartimento di Ematologia, BMT Unit, Pescara, Italy.
16
Rigshospitalet, Copenhagen, Denmark.
17
Hospital Santa Creu i Sant Pau, Jose Carreras Institute, Universitat Autonoma de Barcelona, Barcelona, Spain.
18
CHU Montpellier, Montpellier, France.
19
Chaim Sheba Medical Center, Tel-Hashomer, Israel.
20
ALWP Office Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, AP-HP, Paris, France.
21
Monacord, Centre Scientifique de Monaco, Monaco, France.
22
Churchill Hospital, Oxford University, Oxford, UK.

Abstract

Outcomes after unmanipulated haploidentical stem cell transplantation (Haplo) and after unrelated cord blood transplantation (UCBT) are encouraging and have become alternative options to treat patients with high-risk acute leukemia without human leukocyte antigen (HLA) matched donor. We compared outcomes after UCBT and Haplo in adults with de novo acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Median follow-up was 24 months. Analysis was performed separately for patients with AML, n=918 (Haplo=360, UCBT=558) and ALL, n=528 (Haplo=158 and UCBT=370). UCBT was associated with delayed engraftment and higher graft failure in both AML and ALL recipients. In multivariate analysis, UCBT was associated with lower incidence of chronic graft-vs-host disease both in the AML group (hazard ratio (HR)=0.63, P=0.008) and in the ALL group (HR=0.58, P=0.01). Not statistically significant differences were observed between Haplo and UCBT for relapse incidence (HR=0.95, P=0.76 for AML and HR=0.82, P=0.31 for ALL), non-relapse mortality (HR=1.16, P=0.47 for AML and HR=1.23, P=0.23 for ALL) and leukemia-free survival (HR 0.78, P=0.78 for AML and HR=1.00, P=0.84 for ALL). There were no statistically differences on main outcomes after unmanipulated Haplo and UCBT, and both approaches are valid for acute leukemia patients lacking a HLA matched donor. Both strategies expand the donor pool for patients in need.

PMID:
25882700
DOI:
10.1038/leu.2015.98
[Indexed for MEDLINE]

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