Reduced-Intensity versus Myeloablative Conditioning in Cord Blood Transplantation for Acute Myeloid Leukemia (40-60 years) across Highly Mismatched HLA Barriers-On Behalf of Eurocord and the Cellular Therapy & Immunobiology Working Party (CTIWP) of EBMT
Sheth, Vipul (Fred Hutchison Cancer Research Centre)
Volt, Fernanda (Eurocord)
Sanz, Jaime (Hospital Universitari i Politècnic La Fe (València))
Clement, Laurence (Haut-Lévêque)
Cornelissen, Jan (Erasmus MC-Daniel den Hoed Cancer Centre)
Blaise, Didier (Paoli Calmettes)
Malouf Sierra, Jorge 1971- (Institut d'Investigació Biomèdica Sant Pau)
Michallet, Mauricette (Centre Leon Berard)
Saccardi, Riccardo (Careggi University Hospital (Florència, Itàlia))
Rocha, Vanderson (Eurocord)
Gluckman, Eliane (Eurocord)
Chabannon, Christian (Institut Paoli-Calmettes)
Ruggeri, Annalisa (IRCCS San Raffaele Scientific Institute (Milà, Itàlia))
Universitat Autònoma de Barcelona

Date:	2020
Abstract:	The use of myeloablative conditioning (MAC) in umbilical cord blood transplantation (UCBT) has been associated with high nonrelapse mortality (NRM) in patients aged >40 years, especially those having a high HLA disparity, thus limiting wider applications. We hypothesized that the NRM advantage of reduced-intensity conditioning (RIC) and higher graft-versus-leukemia effect associated with greater HLA disparities would expand its use for patients (aged 40 to 60 years) without compromising efficacy and compared outcomes between RIC and MAC regimens. In total, 288 patients aged 40 to 60 years, with de novo acute myeloid leukemia, receiving UCBT with at least 2 HLA mismatches with RIC (n = 166) or MAC (n = 122) regimens were included. As compared to RIC, the MAC cohort included relatively younger patients, having received more single UCBT, with lower total nucleated cell counts and more in vivo T cell depletion. Median time to neutrophil engraftment, infections (bacterial, viral, and fungal), and grade II to IV acute and chronic graft-versus-host disease were similar in both groups. In the multivariate analysis, overall survival (hazard ratio [HR], 0. 98; P =. 9), NRM (HR, 0. 68; P =. 2), and relapse (HR, 1. 24; P =. 5) were not different between RIC and MAC. Refractory disease was associated with worse survival. Outcomes of UBCT for patients aged 40 to 60 years having ≥2 HLA mismatches are comparable after the RIC or MAC regimen.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Mismatched ; Myeloablative ; Reduced intensity ; Umbilical cord transplant
Published in:	Biology of blood and marrow transplantation, Vol. 26 Núm. 11 (november 2020) , p. 2098-2104, ISSN 1523-6536

DOI: 10.1016/j.bbmt.2020.07.025
PMID: 32726672

7 p, 530.8 KB

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Articles > Research articles
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