TY - JOUR
T1 - Myeloablative Unrelated Cord Blood Transplantation in Adolescents and Young Adults with Acute Leukemia
AU - Eurocord, Cellular Therapy & Immunobiology Working Party, and Paediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation
AU - Hayashi, Hiromi
AU - Volt, Fernanda
AU - Sanz, J.
AU - Petersen, E.
AU - Dhedin, Nathalie
AU - Hough, Rachael
AU - Milpied, Noel
AU - Angelucci, Emanuele
AU - Yakoub-Agha, Ibrahim
AU - Michallet, Mauricette
AU - Michel, Gerard
AU - Aljurf, Mahmoud
AU - Kenzey, Chantal
AU - Rocha, Vanderson
AU - Dalle, Jean Hugues
AU - Bader, P.
AU - Ruggeri, Annalisa
AU - Gluckman, Eliane
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Outcomes for adolescents and young adults (AYAs) with leukemia differ from other age groups and are still under-represented in clinical research. The aim of this study was to analyze outcomes of umbilical cord blood transplant (UCBT) in AYAs with acute leukemia reported to Eurocord/European Society for Blood and Marrow Transplantation. Patients (N = 504) had acute lymphoblastic (59%) or myeloid leukemia (41%), were aged 15 to 25 years, and received UCBT after myeloablative conditioning regimens between 2004 and 2016. The primary endpoint was 3-year overall survival (OS). Median follow-up was 3.9 years. Transplant was single in 58% and double UCBT in 42%. Three-year OS was 45% and leukemia free survival (LFS) was 41%. Cumulative incidence functions (CIFs) of nonrelapse mortality (NRM) and relapse were 31% and 28%, respectively. CIF of acute graft-versus-host disease (GVHD) grades II to IV at day 100 was 28%. Three-year CIF of chronic GVHD was 25%. In adjusted analysis, better disease status at UCBT (hazard ratio [HR], 2.74; P < .001) and more recent UCBT (HR, 1.43; P = .01) were associated with increased OS, and a similar effect of these factors was observed on LFS. Contrastingly, the use of antithymocyte globulin had a negative effect in LFS. The risk of acute GVHD grades II to IV increased with the use of double UCBT (HR, 1.65; P = .02) and decreased with more recent transplant period (HR, .65; P = .02) and antithymocyte globulin use (HR, .55; P = .01). Outcomes of AYA UCBT improved in more recent years, becoming comparable with pediatric results. Demonstrating the feasibility of UCBT in AYAs facilitates stem cell source selection and provides the basis for future prospective studies.
AB - Outcomes for adolescents and young adults (AYAs) with leukemia differ from other age groups and are still under-represented in clinical research. The aim of this study was to analyze outcomes of umbilical cord blood transplant (UCBT) in AYAs with acute leukemia reported to Eurocord/European Society for Blood and Marrow Transplantation. Patients (N = 504) had acute lymphoblastic (59%) or myeloid leukemia (41%), were aged 15 to 25 years, and received UCBT after myeloablative conditioning regimens between 2004 and 2016. The primary endpoint was 3-year overall survival (OS). Median follow-up was 3.9 years. Transplant was single in 58% and double UCBT in 42%. Three-year OS was 45% and leukemia free survival (LFS) was 41%. Cumulative incidence functions (CIFs) of nonrelapse mortality (NRM) and relapse were 31% and 28%, respectively. CIF of acute graft-versus-host disease (GVHD) grades II to IV at day 100 was 28%. Three-year CIF of chronic GVHD was 25%. In adjusted analysis, better disease status at UCBT (hazard ratio [HR], 2.74; P < .001) and more recent UCBT (HR, 1.43; P = .01) were associated with increased OS, and a similar effect of these factors was observed on LFS. Contrastingly, the use of antithymocyte globulin had a negative effect in LFS. The risk of acute GVHD grades II to IV increased with the use of double UCBT (HR, 1.65; P = .02) and decreased with more recent transplant period (HR, .65; P = .02) and antithymocyte globulin use (HR, .55; P = .01). Outcomes of AYA UCBT improved in more recent years, becoming comparable with pediatric results. Demonstrating the feasibility of UCBT in AYAs facilitates stem cell source selection and provides the basis for future prospective studies.
KW - Acute leukemia
KW - Adolescents
KW - Cord blood
KW - Transplantation
KW - Young adults
UR - http://www.scopus.com/inward/record.url?scp=85071859244&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071859244&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2019.07.031
DO - 10.1016/j.bbmt.2019.07.031
M3 - Article
C2 - 31394275
AN - SCOPUS:85071859244
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
SN - 1083-8791
ER -