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. 2021 Feb;56(2):357-367.
doi: 10.1038/s41409-020-01019-6. Epub 2020 Aug 11.

Unrelated cord blood transplantation with myeloablative conditioning for pediatric acute lymphoblastic leukemia in remission: prognostic factors

Yuta Kawahara  1 , Akira Morimoto  2 , Jiro Inagaki  3 , Katsuyoshi Koh  4 , Maiko Noguchi  5 , Hiroaki Goto  6 , Nao Yoshida  7 , Yuko Cho  8 , Tsukasa Hori  9 , Mitsuteru Hiwatari  10 , Keisuke Kato  11 , Atsushi Ogawa  12 , Yoshiko Hashii  13 , Masami Inoue  14 , Koji Kato  15 , Yoshiko Atsuta  16   17 , Fumihiko Kimura  18 , Motohiro Kato  19
Affiliations

Unrelated cord blood transplantation with myeloablative conditioning for pediatric acute lymphoblastic leukemia in remission: prognostic factors

Yuta Kawahara et al. Bone Marrow Transplant. 2021 Feb.

Abstract

The number of individuals undergoing unrelated cord blood transplantation (UCBT) has increased in recent years; however, information on prognostic factors is limited. We retrospectively analyzed data from 475 children and adolescents receiving UCBT with myeloablative conditioning for acute lymphoblastic leukemia (ALL) in complete remission (CR), based on a nationwide registry. In the total patient cohort, 5-year leukemia-free survival (LFS) and overall survival (OS) rates after UCBT were 61.1% and 67.7%, respectively. UCBT at first CR and UCBT after 2007 were associated with good survival, while grade II-IV acute graft-versus-host disease (GVHD) was associated with low relapse rate but did not affect survival. Analysis according to human leukocyte antigen (HLA) disparity revealed that tacrolimus-based GVHD prophylaxis resulted in higher OS and lower relapse rate and nonrelapse mortality (NRM) than cyclosporine-based GVHD prophylaxis in patients transplanted with 6/6 and ≤4/6 HLA-matched umbilical cord blood. Furthermore, grade II-IV acute GVHD was associated with good LFS and low relapse rate, without high NRM, in patients receiving 5/6 HLA-matched UCBT. These data indicate that prognostic factors for ALL differ depending on HLA disparity in UCBT.

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