Comparison of reduced-intensity/toxicity conditioning regimens for umbilical cord blood transplantation for lymphoid malignancies

• Published in: Bone marrow transplantation (Basingstoke) Vol. 55; no. 11; pp. 2098 - 2108
• Main Authors: Imahashi, Nobuhiko, Terakura, Seitaro, Kondo, Eisei, Kako, Shinichi, Uchida, Naoyuki, Kobayashi, Hikaru, Inamoto, Yoshihiro, Sakai, Hitoshi, Tanaka, Masatsugu, Ishikawa, Jun, Kozai, Yasuji, Matsuoka, Ken-ichi, Kimura, Takafumi, Fukuda, Takahiro, Atsuta, Yoshiko, Kanda, Junya
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.11.2020; Nature Publishing Group
• Subjects: 692/699/1541/1990; 692/700/565/2319; Acute lymphoblastic leukemia; Antithymocyte globulin; Blood; Busulfan; Cancer; Cell Biology; Comparative analysis; Conditioning; Cord blood; Cyclophosphamide; Fludarabine; Graft-versus-host reaction; Hematology; Internal Medicine; Irradiation; Leukemia; Lymphatic leukemia; Lymphoma; Medicine; Medicine & Public Health; Melphalan; Methotrexate; Mycophenolate mofetil; Mycophenolic acid; Non-Hodgkin's lymphomas; Prophylaxis; Public Health; Radiation; Stem cell transplantation; Stem Cells; Toxicity; Transplantation; Umbilical cord
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-020-0905-6

To investigate which reduced-intensity conditioning (RIC)/reduced-toxicity conditioning (RTC) is superior for umbilical cord blood transplantation (UCBT) for lymphoid malignancies, we retrospectively compared three widely used RIC/RTC regimens: fludarabine/melphalan/total body irradiation (FM-TBI, n  = 524), fludarabine/cyclophosphamide/total body irradiation (FC-TBI, n  = 96), and fludarabine/busulfan/total body irradiation or melphalan (FB-based, n  = 159). Among patients with acute lymphoblastic leukemia (ALL) ( n  = 314), there were no differences in overall survival (OS) by conditioning regimen. Among patients with malignant lymphoma (ML) ( n  = 465), FM-TBI and FC-TBI regimens had similar OS, whereas FB-based regimen had lower OS (hazard ratio [HR], 1.73; P  < 0.01) than did FM-TBI regimen due to higher non-relapse mortality (HR, 1.72; P  = 0.02). In addition, mycophenolate mofetil-containing GVHD prophylaxis was associated with better OS than methotrexate-containing GVHD prophylaxis among patients who received FM-TBI (HR, 0.65; P  = 0.03) and FC-TBI (HR, 0.25; P  < 0.01) regimens due to a decreased relapse risk. In summary, our results suggest that all three RIC/RTC regimens have comparable clinical outcomes in ALL, while the FM-TBI or FC-TBI regimens combined with mycophenolate mofetil-containing GVHD prophylaxis is preferable in RIC/RTC-UCBT for ML. Large prospective studies are warranted to confirm these results.