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Multicenter Study
. 2016 Jul 12;7(28):43027-43038.
doi: 10.18632/oncotarget.9599.

RIC versus MAC UCBT in adults with AML: A report from Eurocord, the ALWP and the CTIWP of the EBMT

Frédéric Baron  1 , Annalisa Ruggeri  2   3 , Eric Beohou  4 , Myriam Labopin  4 , Guillermo Sanz  5 , Noel Milpied  6   7 , Mauricette Michallet  8 , Andrea Bacigalupo  9 , Didier Blaise  10 , Jorge Sierra  11 , Gérard Socié  12 , Jan J Cornelissen  13 , Christoph Schmid  14 , Sebastian Giebel  15 , Norbert-Claude Gorin  3   4 , Jordi Esteve  16 , Fabio Ciceri  17 , Bipin N Savani  18 , Mohamad Mohty  3   19   20 , Eliane Gluckman  21 , Arnon Nagler  4   22
Affiliations
Multicenter Study

RIC versus MAC UCBT in adults with AML: A report from Eurocord, the ALWP and the CTIWP of the EBMT

Frédéric Baron et al. Oncotarget. .

Abstract

Nonrelapse mortality (NRM) is the first cause of treatment failure after unrelated cord blood transplantation (UCBT) following myeloablative conditioning (MAC). In the last decade, reduced-intensity conditioning (RIC) regimens have been developed with the aim of reducing NRM and allowing older patients and those with medical comorbidities to benefit from UCBT. The aim of the current retrospective study was to compare transplantation outcomes of acute myeloid leukemia (AML) patients given UCBT after either RIC or MAC. Data from 894 adults with AML receiving a single or double UCBT as first allograft from 2004 to 2013 at EBMT centers were included in this study. 415 patients were given UCBT after RIC while 479 patients following a MAC. In comparison to MAC recipients, RIC recipients had a similar incidence of neutrophil engraftment and of acute and chronic graft-versus-host disease (GVHD). However, RIC recipients had a higher incidence of disease relapse and a lower NRM, translating to comparable leukemia-free (LFS), GVHD-free, relapse-free survival (GRFS) and overall survival (OS). These observations remained qualitatively similar after adjusting for differences between groups in multivariate analyses. In conclusion, these data suggest that LFS and OS are similar with RIC or with MAC in adults AML patients transplanted with UCBT. These observations could serve as basis for a future prospective randomized study.

Keywords: AML; myeloablative; reduced-intensity; transplantation; unrelated cord blood.

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Conflict of interest statement

CONFLICTS OF INTERESTS None.

Figures

Figure 1
Figure 1. UCBT outcomes in AML patients transplanted following RIC (n = 415) versus MAC (n = 479)
The figures show the unadjusted curves for MAC patients and the adjusted curves for RIC recipients. Curves were adjusted for age at transplantation, recipient gender, year of transplantation, disease status, TBF conditioning or not, TCF conditioning, or not, and the use of ATG. LFS, leukemia-free survival; OS, overall survival; RI, relapse incidence and NRM, nonrelapse mortality.
Figure 2
Figure 2. Forest plot analysis of cumulative incidence of nonrelapse mortality (A) and relapse (B) HR and 95% confidence intervals were computed using univariate Cox analyses
Figure 2
Figure 2. Forest plot analysis of cumulative incidence of nonrelapse mortality (A) and relapse (B) HR and 95% confidence intervals were computed using univariate Cox analyses
Figure 3
Figure 3. Forest plot analysis of leukemia-free survival (A) and overall survival (B)
HR and 95% confidence intervals were computed using univariate Cox analyses.
Figure 3
Figure 3. Forest plot analysis of leukemia-free survival (A) and overall survival (B)
HR and 95% confidence intervals were computed using univariate Cox analyses.
See this image and copyright information in PMC

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