Unrelated Cord Blood Transplantation for Acute Leukemia Diagnosed in the First Year of Life: Outcomes and Risk Factor Analysis

A. Ruggeri, F. Volt, F. Locatelli, G. Michel, C. Diaz de Heredia, M. Abecasis, M. Zecca, A. Vora, K. Yakouben, T. A. O'Brien, S. Giardino, J. Cornish, V. Rocha, C. Peters, P. Bader, E. Gluckman, J. H. Dalle

Research output: Contribution to journalArticle

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Abstract

Infant acute leukemia still has a poor prognosis, and allogeneic hematopoietic stem cell transplantation is indicated in selected patients. Umbilical cord blood (UCB) is an attractive cell source for this population because of the low risk of chronic graft-versus-host disease (GVHD), the strong graft-versus-leukemia effect, and prompt donor availability. This retrospective, registry-based study reported UCB transplantation (UCBT) outcomes in 252 children with acute lymphoblastic leukemia (ALL; n = 157) or acute myelogenous leukemia (AML; n = 95) diagnosed before 1 year of age who received a single-unit UCBT after myeloablative conditioning between 1996 and 2012 in European Society for Blood and Marrow Transplantation centers. Median age at UCBT was 1.1 years, and median follow-up was 42 months. Most patients (57%) received a graft with 1 HLA disparity and were transplanted in first complete remission (CR; 55%). Cumulative incidence function (CIF) of day 100 acute GVHD (grades II to IV) was 40% +/- 3% and of 4-year chronic GVHD was 13% +/- 2%. CIF of 1-year transplant-related mortality was 23% +/- 3% and of 4-year relapse was 27% +/- 3%. Leukemia-free-survival (LFS) at 4 years was 50% +/- 3%; it was 40% and 66% for those transplanted for ALL and AML, respectively (P = .001). LFS was better for patients transplanted in first CR, regardless of diagnosis. In multivariate model, diagnosis of ALL (P = .001), advanced disease status at UCBT (
Original languageEnglish
Pages (from-to)96-102
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume23
Issue number1
DOIs
Publication statusPublished - Jan 1 2017

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Fetal Blood
Statistical Factor Analysis
Leukemia
Transplantation
Graft vs Host Disease
Transplants
Survival
Hematopoietic Stem Cell Transplantation
Incidence
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Acute Myeloid Leukemia
Registries
Bone Marrow
Tissue Donors
Recurrence
Mortality
Population

Keywords

  • Acute Disease
  • Cord Blood Stem Cell Transplantation/adverse effects/methods/mortality
  • Graft vs Host Disease/etiology
  • Humans
  • Infant
  • Infant, Newborn
  • Leukemia/complications/mortality/therapy
  • Leukemia, Myeloid, Acute/complications/mortality/therapy
  • Myeloablative Agonists/therapeutic use
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/mortality/therapy
  • Registries
  • Remission Induction
  • Retrospective Studies
  • Risk Factors
  • Transplantation Conditioning/methods
  • Treatment Outcome
  • Unrelated Donors
  • Acute leukemia
  • Cord blood transplantation
  • MLL-rearranged leukemia

Cite this

Unrelated Cord Blood Transplantation for Acute Leukemia Diagnosed in the First Year of Life: Outcomes and Risk Factor Analysis. / Ruggeri, A.; Volt, F.; Locatelli, F.; Michel, G.; Heredia, C. Diaz de; Abecasis, M.; Zecca, M.; Vora, A.; Yakouben, K.; O'Brien, T. A.; Giardino, S.; Cornish, J.; Rocha, V.; Peters, C.; Bader, P.; Gluckman, E.; Dalle, J. H.

In: Biology of Blood and Marrow Transplantation, Vol. 23, No. 1, 01.01.2017, p. 96-102.

Research output: Contribution to journalArticle

Ruggeri, A, Volt, F, Locatelli, F, Michel, G, Heredia, CDD, Abecasis, M, Zecca, M, Vora, A, Yakouben, K, O'Brien, TA, Giardino, S, Cornish, J, Rocha, V, Peters, C, Bader, P, Gluckman, E & Dalle, JH 2017, 'Unrelated Cord Blood Transplantation for Acute Leukemia Diagnosed in the First Year of Life: Outcomes and Risk Factor Analysis', Biology of Blood and Marrow Transplantation, vol. 23, no. 1, pp. 96-102. https://doi.org/S1083-8791(16)30428-1 [pii]
Ruggeri, A. ; Volt, F. ; Locatelli, F. ; Michel, G. ; Heredia, C. Diaz de ; Abecasis, M. ; Zecca, M. ; Vora, A. ; Yakouben, K. ; O'Brien, T. A. ; Giardino, S. ; Cornish, J. ; Rocha, V. ; Peters, C. ; Bader, P. ; Gluckman, E. ; Dalle, J. H. / Unrelated Cord Blood Transplantation for Acute Leukemia Diagnosed in the First Year of Life: Outcomes and Risk Factor Analysis. In: Biology of Blood and Marrow Transplantation. 2017 ; Vol. 23, No. 1. pp. 96-102.
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AU - Ruggeri, A.

AU - Volt, F.

AU - Locatelli, F.

AU - Michel, G.

AU - Heredia, C. Diaz de

AU - Abecasis, M.

AU - Zecca, M.

AU - Vora, A.

AU - Yakouben, K.

AU - O'Brien, T. A.

AU - Giardino, S.

AU - Cornish, J.

AU - Rocha, V.

AU - Peters, C.

AU - Bader, P.

AU - Gluckman, E.

AU - Dalle, J. H.

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N2 - Infant acute leukemia still has a poor prognosis, and allogeneic hematopoietic stem cell transplantation is indicated in selected patients. Umbilical cord blood (UCB) is an attractive cell source for this population because of the low risk of chronic graft-versus-host disease (GVHD), the strong graft-versus-leukemia effect, and prompt donor availability. This retrospective, registry-based study reported UCB transplantation (UCBT) outcomes in 252 children with acute lymphoblastic leukemia (ALL; n = 157) or acute myelogenous leukemia (AML; n = 95) diagnosed before 1 year of age who received a single-unit UCBT after myeloablative conditioning between 1996 and 2012 in European Society for Blood and Marrow Transplantation centers. Median age at UCBT was 1.1 years, and median follow-up was 42 months. Most patients (57%) received a graft with 1 HLA disparity and were transplanted in first complete remission (CR; 55%). Cumulative incidence function (CIF) of day 100 acute GVHD (grades II to IV) was 40% +/- 3% and of 4-year chronic GVHD was 13% +/- 2%. CIF of 1-year transplant-related mortality was 23% +/- 3% and of 4-year relapse was 27% +/- 3%. Leukemia-free-survival (LFS) at 4 years was 50% +/- 3%; it was 40% and 66% for those transplanted for ALL and AML, respectively (P = .001). LFS was better for patients transplanted in first CR, regardless of diagnosis. In multivariate model, diagnosis of ALL (P = .001), advanced disease status at UCBT (

AB - Infant acute leukemia still has a poor prognosis, and allogeneic hematopoietic stem cell transplantation is indicated in selected patients. Umbilical cord blood (UCB) is an attractive cell source for this population because of the low risk of chronic graft-versus-host disease (GVHD), the strong graft-versus-leukemia effect, and prompt donor availability. This retrospective, registry-based study reported UCB transplantation (UCBT) outcomes in 252 children with acute lymphoblastic leukemia (ALL; n = 157) or acute myelogenous leukemia (AML; n = 95) diagnosed before 1 year of age who received a single-unit UCBT after myeloablative conditioning between 1996 and 2012 in European Society for Blood and Marrow Transplantation centers. Median age at UCBT was 1.1 years, and median follow-up was 42 months. Most patients (57%) received a graft with 1 HLA disparity and were transplanted in first complete remission (CR; 55%). Cumulative incidence function (CIF) of day 100 acute GVHD (grades II to IV) was 40% +/- 3% and of 4-year chronic GVHD was 13% +/- 2%. CIF of 1-year transplant-related mortality was 23% +/- 3% and of 4-year relapse was 27% +/- 3%. Leukemia-free-survival (LFS) at 4 years was 50% +/- 3%; it was 40% and 66% for those transplanted for ALL and AML, respectively (P = .001). LFS was better for patients transplanted in first CR, regardless of diagnosis. In multivariate model, diagnosis of ALL (P = .001), advanced disease status at UCBT (

KW - Acute Disease

KW - Cord Blood Stem Cell Transplantation/adverse effects/methods/mortality

KW - Graft vs Host Disease/etiology

KW - Humans

KW - Infant

KW - Infant, Newborn

KW - Leukemia/complications/mortality/therapy

KW - Leukemia, Myeloid, Acute/complications/mortality/therapy

KW - Myeloablative Agonists/therapeutic use

KW - Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications/mortality/therapy

KW - Registries

KW - Remission Induction

KW - Retrospective Studies

KW - Risk Factors

KW - Transplantation Conditioning/methods

KW - Treatment Outcome

KW - Unrelated Donors

KW - Acute leukemia

KW - Cord blood transplantation

KW - MLL-rearranged leukemia

U2 - S1083-8791(16)30428-1 [pii]

DO - S1083-8791(16)30428-1 [pii]

M3 - Article

VL - 23

SP - 96

EP - 102

JO - Biology of Blood and Marrow Transplantation

JF - Biology of Blood and Marrow Transplantation

SN - 1083-8791

IS - 1

ER -