Impact of graft-versus-host disease prophylaxis on outcomes after myeloablative single-unit umbilical cord blood transplantation.

Abstract

Myeloablative single-unit umbilical cord blood transplantation (sUCBT) using busulfan, thiotepa, fludarabine, and antithymocyte globulin (Grupo Español de Trasplante Hematopoyético [GETH]-2005 protocol) resulted in high rates of engraftment and high antitumor activity. We designed a new graft-versus-host disease prophylaxis, substituting long-term steroids with mycophenolate mofetil together with a slight reduction of antithymocyte globulin (GETH/Gruppo Italiano Trapianto Midollo Osseo [GITMO]-2008 protocol). The results in 145 consecutive patients were compared with those obtained in 88 patients from the previous GETH-2005 trial. The cumulative incidence (CI) of myeloid engraftment at 60 days for patients in the GETH-2005 and GETH/GITMO-2008 trials was 94% and 88%, respectively, at a median time to neutrophil recovery of 19 and 23 days, respectively (P < .0001). In the multivariable analyses, platelet engraftment, acute and chronic graft-versus-host disease, nonrelapse mortality, relapse, and event-free survival were not significantly different. The 3-year event-free survival rate in the GETH/GITMO-2008 trial was 66%, 31%, and 25% for patients transplanted in early, intermediate, and advanced stages of the disease, respectively (P < .0001). This study confirms that myeloablative sUCBT using busulfan-based conditioning is a valuable strategy for patients with hematological malignancies. The use of mycophenolate mofetil apparently had an adverse effect on myeloid engraftment, and therefore a cautious use of this agent is warranted in the UCBT setting.

• Authors: Jaime Sanz, Alessandra Picardi, Juan C Hernández Boluda, Carmen Martín, Christelle Ferrá, Chiara Nozzoli, Marta Gonzalez-Vicent, Alessandro Rambaldi, David Valcarcel, Amparo Verdeguer, David Serrano, Cristina Díaz de Heredia, María Jesús Pascual, Raquel de Paz, Pau Montesinos, Benedetta Bartolozzi, Alessandra Algarotti, Miguel A Sanz, William Arcese, Guillermo F Sanz, GETH and GITMO
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 19 Issue 9 Pg. 1387-92 (Sep 2013) ISSN: 1523-6536 [Electronic] United States
• PMID: 23850652 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Cord Blood Stem Cell Transplantation (adverse effects, methods)
• Disease-Free Survival
• Female
• Graft Survival
• Graft vs Host Disease (etiology, prevention & control)
• Humans
• Male
• Risk Factors
• Survival Analysis
• Transplantation Conditioning (adverse effects, methods)
• Young Adult