Reduced-Intensity versus Myeloablative Conditioning in Cord Blood Transplantation for Acute Myeloid Leukemia (40-60 years) across Highly Mismatched HLA Barriers—On Behalf of Eurocord and the Cellular Therapy & Immunobiology Working Party (CTIWP) of EBMT

Vipul Sheth, Fernanda Volt, Jaime Sanz, Laurence Clement, Jan Cornelissen, Didier Blaise, Jorge Sierra, Mauricette Michallet, Riccardo Saccardi, Vanderson Rocha, Eliane Gluckman, Christian Chabannon, Annalisa Ruggeri

Research output: Contribution to journalArticlepeer-review

Abstract

The use of myeloablative conditioning (MAC) in umbilical cord blood transplantation (UCBT) has been associated with high nonrelapse mortality (NRM) in patients aged >40 years, especially those having a high HLA disparity, thus limiting wider applications. We hypothesized that the NRM advantage of reduced-intensity conditioning (RIC) and higher graft-versus-leukemia effect associated with greater HLA disparities would expand its use for patients (aged 40 to 60 years) without compromising efficacy and compared outcomes between RIC and MAC regimens. In total, 288 patients aged 40 to 60 years, with de novo acute myeloid leukemia, receiving UCBT with at least 2 HLA mismatches with RIC (n = 166) or MAC (n = 122) regimens were included. As compared to RIC, the MAC cohort included relatively younger patients, having received more single UCBT, with lower total nucleated cell counts and more in vivo T cell depletion. Median time to neutrophil engraftment, infections (bacterial, viral, and fungal), and grade II to IV acute and chronic graft-versus-host disease were similar in both groups. In the multivariate analysis, overall survival (hazard ratio [HR], 0.98; P = .9), NRM (HR, 0.68; P = .2), and relapse (HR, 1.24; P = .5) were not different between RIC and MAC. Refractory disease was associated with worse survival. Outcomes of UBCT for patients aged 40 to 60 years having ≥2 HLA mismatches are comparable after the RIC or MAC regimen.

Original languageEnglish
Pages (from-to)2098-2104
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume26
Issue number11
DOIs
Publication statusPublished - Nov 2020

Keywords

  • Mismatched
  • Myeloablative
  • Reduced intensity
  • Umbilical cord transplant

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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