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

Abstract

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 + cyclophosphamide + 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.

• Authors: Claudio G Brunstein, Mary Eapen, Kwang Woo Ahn, Frederick R Appelbaum, Karen K Ballen, Richard E Champlin, Corey Cutler, Fangyu Kan, Mary J Laughlin, Robert J Soiffer, Daniel J Weisdorf, Anne Woolfrey, John E Wagner
• Journal: Blood (Blood) Vol. 119 Issue 23 Pg. 5591-8 (Jun 07 2012) ISSN: 1528-0020 [Electronic] United States
• PMID: 22496153 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• HLA Antigens

Topics

• Acute Disease
• Adult
• Aged
• Disease-Free Survival
• Fetal Blood (transplantation)
• Graft vs Host Disease (epidemiology, immunology)
• HLA Antigens (immunology)
• Hematopoiesis
• Humans
• Incidence
• Leukemia (diagnosis, physiopathology, surgery, therapy)
• Middle Aged
• Recurrence
• Stem Cell Transplantation (methods)
• Transplantation Conditioning (methods)
• Treatment Outcome
• Unrelated Donors
• Young Adult