Higher survival following transplantation with a mismatched unrelated donor with posttransplant cyclophosphamide-based graft-versus-host disease prophylaxis than with double unit umbilical cord blood in patients with acute myeloid leukemia in first complete remission: A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation
[en] The best donor option for acute myeloid leukemia (AML) patients lacking an HLA-matched donor has remained intensively debated. We herein report the results of a large retrospective registry study comparing hematopoietic cell transplantation (HCT) outcomes between double-unit umbilical cord blood transplantation (dCBT, n = 209) versus 9/10 HLA-matched unrelated donor (UD) with posttransplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis (UD 9/10, n = 270) in patients with AML in first complete remission (CR1). Inclusion criteria consisted of adult patient, AML in CR1 at transplantation, either peripheral blood stem cells (PBSC) from UD 9/10 with PTCy as GVHD prophylaxis or dCBT without PTCy, transplantation between 2013 and 2021, and no in vivo T-cell depletion. The 180-day cumulative incidence of grade II-IV acute GVHD was 29% in UD 9/10 versus 44% in dCBT recipients (p =.001). After adjustment for covariates, dCBT recipients had a higher non-relapse mortality (HR = 2.35, 95% CI: 1.23–4.48; p =.01), comparable relapse incidence (HR = 1.12, 95% CI: 0.67–1.86; p =.66), lower leukemia-free survival (HR = 1.5, 95% CI: 1.01–2.23; p =.047), and lower overall survival (HR = 1.66, 95% CI: 1.08–2.55; p =.02) compared with patients receiving UD 9/10 HCT. In summary, our results suggest that transplantation outcomes are better with UD 9/10 with PTCy-based GVHD prophylaxis than with dCBT for AML patients in CR1. These data might support the use of UD 9/10 with PTCy-based GVHD prophylaxis over dCBT in AML patients lacking an HLA-matched donor.
Disciplines :
Hematology
Author, co-author :
Baron, Frédéric ; Université de Liège - ULiège > Département des sciences cliniques
Labopin, Myriam; EBMT Paris Study Unit, Paris, France ; Clinical Hematology and Cellular Therapy Department, Saint Antoine Hospital, Paris, France ; INSERM UMRs 938, Paris, France ; Sorbonne University, Paris, France
Versluis, Jurjen; Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
Vydra, Jan; Institute of Hematology and Blood Transfusion, Prague, Czech Republic
von dem Borne, Peter A.; Leiden University Medical Center, Leiden, Netherlands
Nicholson, Emma ; Royal Marsden Hospital, London, United Kingdom
Blaise, Didier; Programme de transplantation et d'immunothérapie cellulaire, département d'hématologie, Institut Paoli Calmettes, Laboratoire management sport cancer, Aix Marseille université, Marseille, France
Protheroe, Rachel; University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
Kulagin, Alexander ; RM Gorbacheva Research Institute, Pavlov University, Saint Petersburg, Russian Federation
Bulabois, Claude Eric; CHU Grenoble Alpes – Université Grenoble Alpes, Grenoble, France
Forcade, Edouard; Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, Bordeaux, France
Byrne, Jenny; Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
Sanz, Jaime; Hematology Department, University Hospital La Fe, Spain
Ruggeri, Annalisa ; IRCCS Ospedale San Raffaele s.r.l., Haematology and BMT, Milan, Italy
Mohty, Mohamad; Clinical Hematology and Cellular Therapy Department, Saint Antoine Hospital, Paris, France ; INSERM UMRs 938, Paris, France ; Sorbonne University, Paris, France
Ciceri, Fabio; IRCCS Ospedale San Raffaele s.r.l., Haematology and BMT, Milan, Italy ; Vita-Salute San Raffaele University, Milano, Italy
Higher survival following transplantation with a mismatched unrelated donor with posttransplant cyclophosphamide-based graft-versus-host disease prophylaxis than with double unit umbilical cord blood in patients with acute myeloid leukemia in first complete remission: A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation
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