Unrelated cord blood transplantation in adult and pediatric acute lymphoblastic leukemia: effect of minimal residual disease on relapse and survival.

Abstract

Data on pretransplantation minimal residual disease (MRD) and outcomes of umbilical cord blood transplantation (UCBT) are limited. Out of the 143 patients with acute lymphoblastic leukemia (ALL) who underwent UCBT at the University of Minnesota between 2004 and 2010, we evaluated 86 patients with available MRD assessment data by 4- and 8-color flow cytometry analysis immediately before transplantation. Ten patients (11.6%) were MRD-positive, and 76 were MRD-negative (88.4%). Most of the patients (82%) received myeloablative conditioning. GVHD prophylaxis consisted of cyclosporine and mycophenolate mofetil. In multivariate analysis, age, disease status (complete remission [CR] 1 versus CR2/CR3), disease group (precursor B cell ALL versus Philadelphia chromosome-positive ALL versus T cell ALL), and time to transplantation had no impact on relapse. Patients with MRD before UCBT had a greater incidence of relapse at 2 years (relapse rate, 30%; 95% confidence interval [CI], 4%-56%) and lower 3-year disease-free survival (30%; 95% CI, 7%-58%) compared with those without MRD (relapse rate, 16%; 95% CI, 8%-25%; P = .05; disease-free survival, 55%; 95% CI, 43%-66%; P = .02). Our data suggest that in patients with ALL, achieving an MRD-negative state before UCBT improves outcomes.

• Authors: Veronika Bachanova, Michael J Burke, Sophia Yohe, Qing Cao, Karamjeet Sandhu, Timothy P Singleton, Claudio G Brunstein, John E Wagner, Michael R Verneris, Daniel J Weisdorf
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 18 Issue 6 Pg. 963-8 (Jun 2012) ISSN: 1523-6536 [Electronic] United States
• PMID: 22430088 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Copyright © 2012 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antineoplastic Agents
• Cyclosporine
• Mycophenolic Acid

Topics

• Adolescent
• Adult
• Age Factors
• Antineoplastic Agents (administration & dosage)
• Child
• Child, Preschool
• Cord Blood Stem Cell Transplantation
• Cyclosporine (administration & dosage)
• Disease-Free Survival
• Female
• Fetal Blood (immunology, transplantation)
• Graft vs Host Disease (prevention & control)
• Humans
• Infant
• Male
• Middle Aged
• Mycophenolic Acid (administration & dosage, analogs & derivatives)
• Neoplasm, Residual (immunology, mortality, therapy)
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (immunology, mortality, therapy)
• Secondary Prevention
• Transplantation Conditioning (methods)
• Transplantation, Homologous
• Treatment Outcome
• Unrelated Donors