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Clinical Trial
. 2011 Jul 14;118(2):282-8.
doi: 10.1182/blood-2011-03-344853. Epub 2011 Apr 28.

Alternative donor transplantation after reduced intensity conditioning: results of parallel phase 2 trials using partially HLA-mismatched related bone marrow or unrelated double umbilical cord blood grafts

Claudio G Brunstein  1 , Ephraim J Fuchs, Shelly L Carter, Chatchada Karanes, Luciano J Costa, Juan Wu, Steven M Devine, John R Wingard, Omar S Aljitawi, Corey S Cutler, Madan H Jagasia, Karen K Ballen, Mary Eapen, Paul V O'Donnell; Blood and Marrow Transplant Clinical Trials Network
Collaborators, Affiliations
Clinical Trial

Alternative donor transplantation after reduced intensity conditioning: results of parallel phase 2 trials using partially HLA-mismatched related bone marrow or unrelated double umbilical cord blood grafts

Claudio G Brunstein et al. Blood. .

Abstract

The Blood and Marrow Transplant Clinical Trials Network conducted 2 parallel multicenter phase 2 trials for individuals with leukemia or lymphoma and no suitable related donor. Reduced intensity conditioning (RIC) was used with either unrelated double umbilical cord blood (dUCB) or HLA-haploidentical related donor bone marrow (Haplo-marrow) transplantation. For both trials, the transplantation conditioning regimen incorporated cyclophosphamide, fludarabine, and 200 cGy of total body irradiation. The 1-year probabilities of overall and progression-free survival were 54% and 46%, respectively, after dUCB transplantation (n = 50) and 62% and 48%, respectively, after Haplo-marrow transplantation (n = 50). The day +56 cumulative incidence of neutrophil recovery was 94% after dUCB and 96% after Haplo-marrow transplantation. The 100-day cumulative incidence of grade II-IV acute GVHD was 40% after dUCB and 32% after Haplo-marrow transplantation. The 1-year cumulative incidences of nonrelapse mortality and relapse after dUCB transplantation were 24% and 31%, respectively, with corresponding results of 7% and 45%, respectively, after Haplo-marrow transplantation. These multicenter studies confirm the utility of dUCB and Haplo-marrow as alternative donor sources and set the stage for a multicenter randomized clinical trial to assess the relative efficacy of these 2 strategies. The trials are registered at www.clinicaltrials.gov under NCT00864227 (BMT CTN 0604) and NCT00849147 (BMT CTN 0603).

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Figures

Figure 1
Figure 1
Treatment plans. Treatment schemas for (A) RIC and dUCB transplantation and (B) haplo-marrow transplantation.
Figure 2
Figure 2
Hematopoietic recovery. Neutrophil (A,C) and platelet recovery (B,D) after RIC and dUCB (A-B) or Haplo-marrow (C-D) transplantation.
Figure 3
Figure 3
GVHD. Cumulative incidences of acute (A,C) and chronic (B,D) GVHC after RIC with either dUCB transplantation (A-B) or Haplo-marrow transplantation (C-D).
Figure 4
Figure 4
Long-term outcomes. Relapse and NRM (A,C), OS, and event-free survival (B,D) after RIC and either dUCB (A-B) or Haplo-marrow transplantation (C-D).
See this image and copyright information in PMC

Comment in

References

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