Reduced-intensity conditioning transplantation in acute leukemia: the effect of source of unrelated donor stem cells on outcomes

• Published in: Blood Vol. 119; no. 23; pp. 5591 - 5598
• Main Authors: Brunstein, Claudio G., Eapen, Mary, Ahn, Kwang Woo, Appelbaum, Frederick R., Ballen, Karen K., Champlin, Richard E., Cutler, Corey, Kan, Fangyu, Laughlin, Mary J., Soiffer, Robert J., Weisdorf, Daniel J., Woolfrey, Anne, Wagner, John E.
• Format: Journal Article
• Language: English
• Published: Washington, DC Elsevier Inc 07.06.2012; Americain Society of Hematology; American Society of Hematology
• Subjects: Acute Disease; Adult; Aged; Biological and medical sciences; Clinical Trials and Observations; Disease-Free Survival; Fetal Blood - transplantation; Graft vs Host Disease - epidemiology; Graft vs Host Disease - immunology; Hematologic and hematopoietic diseases; Hematopoiesis; HLA Antigens - immunology; Humans; Incidence; Leukemia - diagnosis; Leukemia - physiopathology; Leukemia - surgery; Leukemia - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Medical sciences; Middle Aged; Recurrence; Stem Cell Transplantation - methods; Transplantation; Transplantation Conditioning - methods; Treatment Outcome; Unrelated Donors; Young Adult; Prognosis; Hematology; Unrelated donor; Acute leukemia; Malignant hemopathy; Non myeloablative treatment; Cancer
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2011-12-400630

We report the relative efficacy of co-infusing 2 umbilical cord blood units (dUCB) compared with peripheral blood progenitor cells (PBPCs) from 8 of 8 or 7 of 8 HLA-matched unrelated donors. All patients received reduced-intensity conditioning (RIC) regimens. Four treatment groups were evaluated: 4-6 of 6 matched dUCB-TCF (n = 120; TCF = total body irradiation [TBI] 200 cGy + cyclophos-phamide + fludarabine), 4-6 of 6 matched dUCB-other (n = 40; alkylating agent + fludarabine ± TBI), and 8 of 8 (n = 313) and 7 of 8 HLA-matched PBPCs (n = 111). Compared with matched 8 of 8 PBPC transplantations, transplantation-related mortality (TRM), and overall mortality were similar after dUCB-TCF (relative risk [RR] 0.72, P = .72; RR 0.93, P = .60) but higher after dUCB-other RIC (hazard ratio [HR] 2.70, P = .0001; 1.79 P = .004). Compared with 7 of 8 PBPC transplantations, TRM (but not overall mortality) was lower after dUCB-TCF (RR 0.57, P = .04; RR 0.87 P = .41). The probabilities of survival after dUCB-TCF, dUCB-other RIC, and 8 of 8 PBPC and 7 of 8 PBPC transplantations were 38%, 19%, 44%, and 37%, respectively. With similar survival after 8 of 8, 7 of 8 matched PBPCs, and dUCB-TCF, these data support use of dUCB-TCF transplantation in adults with acute leukemia who may benefit from RIC transplantation urgently or lack a 7-8 of 8 unrelated donor.