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. 2012 Jun 7;119(23):5591-8.
doi: 10.1182/blood-2011-12-400630. Epub 2012 Apr 10.

Reduced-intensity conditioning transplantation in acute leukemia: the effect of source of unrelated donor stem cells on outcomes

Claudio G Brunstein  1 , Mary Eapen, Kwang Woo Ahn, Frederick R Appelbaum, Karen K Ballen, Richard E Champlin, Corey Cutler, Fangyu Kan, Mary J Laughlin, Robert J Soiffer, Daniel J Weisdorf, Anne Woolfrey, John E Wagner
Affiliations

Reduced-intensity conditioning transplantation in acute leukemia: the effect of source of unrelated donor stem cells on outcomes

Claudio G Brunstein et al. Blood. .

Abstract

We report the relative efficacy of co-infusing 2 umbilical cord blood units (dUCB) compared with peripheral blood progenitor cells (PBPCs) from 8 of 8 or 7 of 8 HLA-matched unrelated donors. All patients received reduced-intensity conditioning (RIC) regimens. Four treatment groups were evaluated: 4-6 of 6 matched dUCB-TCF (n = 120; TCF = total body irradiation [TBI] 200 cGy + cyclophosphamide + fludarabine), 4-6 of 6 matched dUCB-other (n = 40; alkylating agent + fludarabine ± TBI), and 8 of 8 (n = 313) and 7 of 8 HLA-matched PBPCs (n = 111). Compared with matched 8 of 8 PBPC transplantations, transplantation-related mortality (TRM), and overall mortality were similar after dUCB-TCF (relative risk [RR] 0.72, P = .72; RR 0.93, P = .60) but higher after dUCB-other RIC (hazard ratio [HR] 2.70, P = .0001; 1.79 P = .004). Compared with 7 of 8 PBPC transplantations, TRM (but not overall mortality) was lower after dUCB-TCF (RR 0.57, P = .04; RR 0.87 P = .41). The probabilities of survival after dUCB-TCF, dUCB-other RIC, and 8 of 8 PBPC and 7 of 8 PBPC transplantations were 38%, 19%, 44%, and 37%, respectively. With similar survival after 8 of 8, 7 of 8 matched PBPCs, and dUCB-TCF, these data support use of dUCB-TCF transplantation in adults with acute leukemia who may benefit from RIC transplantation urgently or lack a 7-8 of 8 unrelated donor.

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Figures

Figure 1
Figure 1
Survival after transplantation. (A) The probabilities of LFS after dUCB-TCF, dUCB-other regimen, 8/8 PBPCs, and 7/8 PBPC transplantations adjusted for disease status at transplantation and performance score. (B) The probabilities of LFS after dUCB-TCF, dUCB-other regimen, 8/8 PBPCs, and 7/8 PBPC transplantations for patients who received transplants in CR. (C) The probabilities of OS after dUCB-TCF, dUCB-other regimen, 8/8 PBPCs, and 7/8 PBPC transplantations adjusted for patients who received transplants in relapse or primary induction failure. (D) The probabilities of OS after dUCB-TCF, dUCB-other regimen, 8/8 PBPCs, and 7/8 PBPC transplantations adjusted for disease status at transplantation and performance score.
Figure 2
Figure 2
The probabilities of transplantation-related mortality after dUCB-TCF, dUCB-other regimen, 8/8 PBPCs, and 7/8 PBPC transplantations.
Figure 3
Figure 3
The probabilities of neutrophil recovery after dUCB-TCF, dUCB-other regimen, 8/8 PBPCs, and 7/8 PBPC transplantations.
See this image and copyright information in PMC

References

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