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Bone Marrow Transplant. 2019 May 31. doi: 10.1038/s41409-019-0582-5. [Epub ahead of print]

Hematopoietic stem cell transplantation with unrelated cord blood or haploidentical donor grafts in adult patients with secondary acute myeloid leukemia, a comparative study from Eurocord and the ALWP EBMT.

Author information

1
Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Piazza S.Onofrio, 4, Roma, 00165, Italy. annalisaruggeri80@hotmail.com.
2
Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, AP-HP, Paris, France.
3
Vanderbilt University Medical Center, Nashville, TN, USA.
4
Institut Paoli Calmettes, Marseille, France.
5
Hôpital Saint Louis, Eurocord, IUH University Paris VII, Paris, France.
6
Monacord, Centre Scientifique de Monaco, Monaco, Monaco.
7
Hematology and BMT Unit, San Raffaele Scientific Institute, Milano, Italy.
8
Hematology Department, Fondazione Policlinico Universitario Agostino Gemelli, Universita' Cattolica deI Sacro Cuore, Rome, Italy.
9
Ludwig Maximilian University Hospital of Munich, Munich, Germany.
10
Service d'hématologie, Hôtel Dieu, Nantes, France.
11
Medical Park, Stem Cell Transplant Unit, Antalya, Turkey.
12
Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands.
13
Universitätsklinikum Carl Gustav Carus der TU Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany.
14
Hospital Universitario y Politécnico La Fe, Valencia, Spain.
15
CIBERONC, Madrid, Spain.
16
Hopital Jean Minjoz, Service d'Hématologie, Besançon, France.
17
Department of Hematology, CHU of Liège, 4000, Liège, Belgium.
18
INSERM, UMRs 938, Paris, France.
19
Chaim Sheba Medical Center, Tel-Hashomer, Israel.

Abstract

Survival of patients with secondary acute myeloid leukemia (sAML) is poor. Cord blood transplantation (UCBT) and non-T-cell-depleted stem cell transplantation from haploidentical donors (HAPLO) are both strategies that have shown encouraging results in patients who do not have an human leukocyte antigen (HLA)-matched sibling or unrelated donor. We retrospectively analyzed outcomes of 409 adults with sAML receiving either UCBT (n = 163) or HAPLO (n = 246) in EBMT centers. Myelodysplastic syndrome (MDS) or myeloproliferative disorder (MPD) was the antecedent diagnosis in 79% of UCBT and 85% of HAPLO recipients. In multivariate analysis, UCBT was associated with higher risk of grade II-IV acute GVHD (HR 1.9, p = 0.009) and lower GHVD-free-relapse-free-survival (GRFS) (HR 1.57, p = 0.007) compared to HAPLO. Chronic-GVHD, RI, NRM, LFS, and OS were not statistically different between the two. Early disease stage at transplant was independently associated with lower RI and NRM and higher OS and LFS. These results indicate that HAPLO is associated with better GRFS and lower aGvHD compared to UCBT in patients with sAML and that UCBT can be a valid alternative for sAML patients who lack a matched sibling, a proper haploidentical or an unrelated donor.

PMID:
31150016
DOI:
10.1038/s41409-019-0582-5

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