Comparison of umbilical cord blood allogeneic stem cell transplantation vs. auto-SCT for adult acute myeloid leukemia patients in second complete remission at transplant: a retrospective study on behalf of the SFGM-TC.

Abstract

This retrospective study considered the outcomes of 181 patients with acute myeloid leukemia (AML) transplanted in second complete remission (CR2) between January 2005 and April 2012 and who received either a myeloablative autologous stem cell transplant (Auto-SCT; n = 82; median age: 48 years; median follow-up: 45 months) or an umbilical cord blood (UCB) allogeneic SCT (n = 99, median age: 46 years; median follow-up: 36 months; conditioning regimens: myeloablative n = 21, reduced n = 78; single unit n = 37, double units n = 62). Although the Auto group showed a significant better prognostic profile at transplant, with longer median interval between diagnosis and time of graft, higher incidence of good-risk cytogenetics and lower number of previously transplanted patients, 3-year OS and LFS were similar between both groups (Auto: 59 ± 6% vs. 50 ± 6%, P = 0.45; and 57 ± 6% vs. 46 ± 6%, P = 0.37). In multivariate analysis, UCB allo-SCT was associated with lower relapse incidence (HR: 0.3, 95% CI: 0.11-0.82, P = 0.02), but higher non-relapse mortality (NRM) (HR: 4.16; 95% CI: 1.46-11.9, P = 0.008). Results from this large study suggest that UCB allo-SCT provides better disease control than auto-SCT, which is especially important in the setting of high-risk disease. However, this disease control advantage is counterbalanced by higher toxicity, highlighting the need for novel approaches aiming to decrease NRM after UCB allo-SCT.

• Authors: Patrice Chevallier, Myriam Labopin, Gerard Socie, Marie-There Rubio, Didier Blaise, Stephane Vigouroux, Anne Huynh, Mauricette Michallet, Jacques-Olivier Bay, Sébastien Maury, Ibrahim Yakoub-Agha, Nathalie Fegueux, Eric Deconinck, Nathalie Contentin, Natacha Maillard, Claude-Eric Bulabois, Sylvie Francois, Reman Oumedaly, Nicole Raus, Mohamad Mohty
• Journal: European journal of haematology (Eur J Haematol) Vol. 94 Issue 5 Pg. 449-55 (May 2015) ISSN: 1600-0609 [Electronic] England
• PMID: 25238651 (Publication Type: Comparative Study, Journal Article, Multicenter Study)
• Copyright: © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Antineoplastic Agents

Topics

• Adult
• Aged
• Antineoplastic Agents (therapeutic use)
• Cord Blood Stem Cell Transplantation
• Female
• Hematopoietic Stem Cell Transplantation
• Humans
• Leukemia, Myeloid, Acute (diagnosis, mortality, pathology, therapy)
• Male
• Middle Aged
• Multivariate Analysis
• Prognosis
• Recurrence
• Registries
• Remission Induction
• Retrospective Studies
• Survival Analysis
• Transplantation Conditioning (methods)
• Transplantation, Autologous
• Transplantation, Homologous