Poor outcome with nonmyeloablative conditioning regimen before cord blood transplantation for patients with high-risk acute myeloid leukemia compared with matched related or unrelated donor transplantation

Samia Harbi, Sabine Fürst, Roberto Crocchiolo, Jean El-Cheikh, Luca Castagna, Anne Etienne, Boris Calmels, Claude Lemarie, Thomas Prebet, Angela Granata, Aude Charbonnier, JérÔme Rey, Christian Chabannon, Catherine Faucher, Norbert Vey, Didier Blaise

Research output: Contribution to journalArticlepeer-review

Abstract

Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is recommended for patients with high-risk acute myeloid leukemia (AML). In many situations, a matched related (MRD) or matched unrelated donor (MUD) is lacking, in which case unrelated cord blood units (UCB) provide an alternative. We analyzed the outcome of consecutive high-risk AML patients prepared with reduced-intensity conditioning (RIC) regimens and allografted with UCB (n=32) and compared their outcome with high-risk AML patients who underwent transplantation with MRD/MUD (n=49) in the same period of time. Grade III to IV acute graft-versus-host disease (GVHD) occurred slightly more frequently in the UCB group (25%) than in the MRD/MUD group (8%) (P=069). Conversely, we found a lower incidence of extensive chronic GVHD in the UCB group (6%) than in the MRD/MUD group (20%, P=085). Nonrelapse mortality at 4years was 16% and 22% in the UCB and MRD/MUD groups, respectively (P=529). The cumulative incidence of relapse at 4years was significantly higher in the UCB group (60%) than in the MRD/MUD group (27%, P=006). Leukemia-free survival (LFS) and overall survival (OS) at 4years were 25% and 34%, respectively, in the UCB group and 50% and 56%, respectively, in the MRD/MUD group (LFS, P=029; OS, P=072). Multivariate analyses adjusted by cytogenetics and disease status at the time of Allo-HSCT revealed that use of UCB remained an independent predictive factor of shorter LFS (hazard ratio, 2.0; 95% confidence interval, 1.1 to 3.6; P=018), and was associated with a trend for shorter OS (hazard ratio, 1.7; 95% confidence interval, .9 to 3.2; P=093). Whereas UCB provides an alternative for patients with high-risk AML lacking an MRD/MUD, the high incidence of relapse after RIC-based UCB Allo-HSCT is a concern. Attempts to improve leukemic control with UCB Allo-HSCT are warranted, as well as the evaluation of other alternative donors in this context.

Original languageEnglish
Pages (from-to)1560-1565
Number of pages6
JournalBiology of Blood and Marrow Transplantation
Volume20
Issue number10
DOIs
Publication statusPublished - Oct 1 2014

Keywords

  • Acute myeloid leukemia
  • Allogeneic hematopoietic stem cell transplantation
  • Cord blood transplantation
  • Reduced-intensity conditioning regimen

ASJC Scopus subject areas

  • Transplantation
  • Hematology
  • Medicine(all)

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