Comparison of outcomes after single or double cord blood transplantation in adults with acute leukemia using different types of myeloablative conditioning regimen, a retrospective study on behalf of Eurocord and the Acute Leukemia Working Party of EBMT

• Published in: Leukemia Vol. 28; no. 4; pp. 779 - 786
• Main Authors: Ruggeri, A, Sanz, G, Bittencourt, H, Sanz, J, Rambaldi, A, Volt, F, Yakoub-Agha, I, Ribera, J M, Mannone, L, Sierra, J, Mohty, M, Solano, C, Nabhan, S, Arcese, W, Gluckman, E, Labopin, M, Rocha, V
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.04.2014; Nature Publishing Group
• Subjects: 692/699/67/1990/283; 692/700/565/545/576/1955; Acute leukemia; Adolescent; Adult; Adults; Analysis; Antigens, CD34 - analysis; Antilymphocyte serum; Blood; Busulfan; Cancer Research; Conditioning; Cord blood; Cord Blood Stem Cell Transplantation - adverse effects; Critical Care Medicine; Cyclophosphamide; Female; Fetal blood; Fludarabine; Globulins; Graft versus host disease; Graft vs Host Disease - etiology; Graft-versus-host reaction; Hematology; Humans; Intensive; Internal Medicine; Irradiation; Leukemia; Leukemia research; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - surgery; Leukocytes (neutrophilic); Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Oncology; original-article; Patient outcomes; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Precursor Cell Lymphoblastic Leukemia-Lymphoma - surgery; Radiation; Remission; Remission (Medicine); Retrospective Studies; Stem cell transplantation; Thymocytes; Transplantation; Transplantation Conditioning; Treatment Outcome; Umbilical cord; France; Paris France; Spain; cord blood transplantation; myeloablative conditioning regimen; acute leukemia
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/leu.2013.259

We report outcomes after single (s) and double (d) umbilical cord blood transplantation (UCBT) after myeloablative conditioning (MAC) regimen for 239 patients transplanted for acute leukemia in first complete remission (CR1). All sUCBT patients received a total nucleated cell dose >2.5 × 10 7 /kg. Conditioning regimen for sUCBT was total body irradiation (TBI)12 Gy- or busulfan (BU)-based±fludarabine (Flu) ( n =68, group 1), thiotepa+BU+Flu (TBF) ( n =88, group 2), and for dUCBT it was TBI12 Gy+cyclophosphamide±Flu ( n =83, group 3). dUCBT recipients were younger, received higher cell dose and less frequently antithymocyte globulin. In multivariate analysis, we found similar neutrophil recovery among the three groups; however, acute graft-versus-host disease II–IV was higher in dUCBT compared with others. Non-relapse mortality and relapse incidence were not statistically different among the three groups. Leukemia-free survival was 30% for sUCBT using TBI- or BU-based MAC compared with 48% for sUCBT TBF and 48% for dUCBT ( P =0.02 and P =0.03, respectively), and it was not statistically different between sUCBT with TBF and dUCBT. In conclusion, use of sUCBT with adequate cell dose (>2.5 × 10 7 /kg) and a specific conditioning regimen in the MAC setting results in similar outcomes as dUCBT. The choice of TBF conditioning regimen for sUCBT may improve results, and whether this regimen may be effective in dUCBT should be further analyzed.