Comparison of Outcomes of 8/8 and 7/8 Allele-Matched Unrelated Bone Marrow Transplantation and Single-Unit Cord Blood Transplantation in Adults with Acute Leukemia.

Abstract

To investigate an up-to-date alternative donor selection strategy, we compared the transplantation outcomes of 8/8 and 7/8 allele-matched unrelated bone marrow transplantation (UBMT) with those of umbilical cord blood transplantation (UCBT) and redefined the role of UCBT with extended analysis. Using Cox and competing risk regression analyses, we analyzed the transplantation outcomes in adult patients with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). A total of 2472 first myeloablative transplantations between 2000 and 2010 were included (8/8 UBMT, 1001; 7/8 UBMT, 656; UCBT, 815). For acute and chronic graft-versus-host disease (GVHD) and nonrelapse mortality (NRM), we applied the combined analyses including both AML and ALL data. In the multivariate analyses, severe acute GVHD and NRM after UCBT were comparable with 8/8 UBMT, whereas those after 7/8 UBMT were significantly higher. The incidence of extensive chronic GVHD was significantly lower with UCBT compared with after 8/8 and 7/8 UBMT. With adjusted analyses for AML, UCBT and 8/8 UBMT showed similar overall survival (OS), whereas 7/8 UBMT showed inferior OS. For ALL, we found no significant difference in OS among the 3 groups. Cord blood may be the first choice alternative to 8/8 UBMT for both AML and ALL.

• Authors: Seitaro Terakura, Yoshiko Atsuta, Nobuhiro Tsukada, Takeshi Kobayashi, Masatsugu Tanaka, Junya Kanda, Yuho Najima, Takahiro Fukuda, Naoyuki Uchida, Satoshi Takahashi, Tokiko Nagamura-Inoue, Yasuo Morishima, Koichi Miyamura, Japan Society for Hematopoietic Cell Transplantation
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 22 Issue 2 Pg. 330-338 (Feb 2016) ISSN: 1523-6536 [Electronic] United States
• PMID: 26476205 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2016 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Alleles
• Bone Marrow Transplantation (methods)
• Cord Blood Stem Cell Transplantation (methods)
• Female
• Humans
• Leukemia, Myeloid, Acute (therapy)
• Male
• Middle Aged
• Treatment Outcome
• Young Adult