High progression-free survival after intermediate intensity double unit cord blood transplantation in adults

• Published in: Blood advances Vol. 4; no. 23; pp. 6064 - 6076
• Main Authors: Barker, Juliet N., Devlin, Sean M., Naputo, Kristine A., Skinner, Kelcey, Maloy, Molly A., Flynn, Lisa, Anagnostou, Theodora, Avecilla, Scott T., Scaradavou, Andromachi, Cho, Christina, Dahi, Parastoo B., Giralt, Sergio A., Gyurkocza, Boglarka, Hanash, Alan M., Hsu, Katharine, Jakubowski, Ann A., Papadopoulos, Esperanza B., Peled, Jonathan U., Perales, Miguel-Angel, Sauter, Craig S., Shah, Gunjan L., Shaffer, Brian C., Tamari, Roni, Young, James W., Roshal, Mikhail, O'Reilly, Richard J., Ponce, Doris M., Politikos, Ioannis
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 08.12.2020; American Society of Hematology
• Subjects: Adult; Cord Blood Stem Cell Transplantation; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Middle Aged; Progression-Free Survival; Transplantation; Transplantation Conditioning; Young Adult
• ISSN: 2473-9529; 2473-9537
• DOI: 10.1182/bloodadvances.2020003371

Cord blood transplantation (CBT) after high intensity or nonmyeloablative conditioning has limitations. We investigated cyclosporine-A/mycophenolate mofetil–based intermediate intensity (cyclophosphamide 50 mg/kg, fludarabine 150 mg/m2, thiotepa 10 mg/kg, total body irradiation 400 cGy) unmanipulated double-unit CBT (dCBT) with prioritization of unit quality and CD34+ cell dose in graft selection. Ninety adults (median age, 47 years [range, 21-63]; median hematopoietic cell transplantation comorbidity index, 2 [range, 0-8]; 61 [68%] acute leukemia) received double-unit grafts (median CD34+ cell dose, 1.3 × 105/kg per unit [range, 0.2-8.3]; median donor-recipient human leukocyte antigen (HLA) match, 5/8 [range 3-7/8]). The cumulative incidences of sustained CB engraftment, day 180 grade III-IV acute, and 3-year chronic graft-versus-host disease were 99%, 24%, and 7%, respectively. Three-year transplant-related mortality (TRM) and relapse incidences were 15% and 9%, respectively. Three-year overall survival (OS) is 82%, and progression-free survival (PFS) is 76%. Younger age and higher engrafting unit CD34+ cell dose both improved TRM and OS, although neither impacted PFS. Engrafting unit-recipient HLA match was not associated with any outcome with a 3-year PFS of 79% in 39 patients engrafting with 3-4/8 HLA-matched units. In 52 remission acute leukemia patients, there was no association between minimal residual disease (MRD) and 3-year PFS: MRD negative of 88% vs MRD positive of 77% (P = .375). Intermediate intensity dCBT is associated with high PFS. Use of highly HLA mismatched and unmanipulated grafts permits wide application of this therapy, and the low relapse rates support robust graft-versus-leukemia effects even in patients with MRD. •Intermediate intensity double unit CBT is associated with high progression-free survival in adults, including those with MRD.•Use of highly HLA mismatched and unmanipulated grafts permits wide application of this therapy. [Display omitted]