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Clinical Trial
. 2009 Nov 5;114(19):4293-9.
doi: 10.1182/blood-2009-05-220525. Epub 2009 Aug 25.

Relapse risk after umbilical cord blood transplantation: enhanced graft-versus-leukemia effect in recipients of 2 units

Michael R Verneris  1 , Claudio G Brunstein, Juliet Barker, Margaret L MacMillan, Todd DeFor, David H McKenna, Michael J Burke, Bruce R Blazar, Jeffrey S Miller, Philip B McGlave, Daniel J Weisdorf, John E Wagner
Affiliations
Clinical Trial

Relapse risk after umbilical cord blood transplantation: enhanced graft-versus-leukemia effect in recipients of 2 units

Michael R Verneris et al. Blood. .

Abstract

Umbilical cord blood (UCB) transplantation is potentially curative for acute leukemia. This analysis was performed to identify risk factors associated with leukemia relapse following myeloablative UCB transplantation. Acute leukemia patients (n = 177; 88 with acute lymphoblastic leukemia and 89 with acute myeloid leukemia) were treated at a single center. Patients received a UCB graft composed of either 1 (47%) or 2 (53%) partially human leukocyte antigen (HLA)-matched unit(s). Conditioning was with cyclophosphamide and total body irradiation with or without fludarabine. The incidence of relapse was 26% (95% confidence interval [CI], 19%-33%). In multivariate analysis, relapse was higher in advanced disease patients (> or = third complete remission [CR3]; relative risk [RR], 3.6; P < .01), with a trend toward less relapse in recipients of 2 UCB units (RR = 0.6; P = .07). However, relapse was lower for CR1-2 patients who received 2 UCB units (RR 0.5; P < .03). Leukemia-free survival was 40% (95% CI, 30%-51%) and 51% (95% CI, 41%-62%) for single- and double-unit recipients, respectively (P = .35). Although it is known that transplantation in CR1 and CR2 is associated with less relapse risk, this analysis reveals an enhanced graft-versus-leukemia effect in acute leukemia patients after transplantation with 2 partially HLA-matched UCB units. This trial was registered at http://clinicaltrials.gov as NCT00309842.

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Figures

Figure 1
Figure 1
Probability of leukemia relapse for all patients based on the number of units infused. Shown are the relapse curves for all patients in this study (N = 177). The number of patients at risk for relapse is listed below each time point.
Figure 2
Figure 2
Probability of leukemia relapse based on the number of units and diagnosis for patients who underwent transplantation in CR1-2. Shown are the univariate analysis for relapse in patients who underwent transplantation in CR1-2 for ALL (n = 62) and AML (n = 71). The number of patients at risk for relapse is listed below each time point.
Figure 3
Figure 3
Overall survival for CR1-2 patients based on the number of units infused.
See this image and copyright information in PMC

Comment in

  • Are 2 cords better than 1?
    Delaney M. Delaney M. Blood. 2009 Nov 5;114(19):3980-1. doi: 10.1182/blood-2009-09-241430. Blood. 2009. PMID: 19892726 No abstract available.

References

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