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. 2022 Oct 9;13(1):500.
doi: 10.1186/s13287-022-03186-3.

Unrelated cord blood transplantation vs. HLA-matched sibling transplantation for adults with B-cell acute lymphoblastic leukemia in complete remission: superior OS for patients with long-term survival

Guangyu Sun  1   2   3 , Baolin Tang  1   2   3 , Kaidi Song  1 , Yue Wu  1 , Meijuan Tu  1 , Xiang Wan  1   2   3 , Wen Yao  1 , Liangquan Geng  1 , Ping Qiang  1 , Xiaoyu Zhu  4   5   6
Affiliations

Unrelated cord blood transplantation vs. HLA-matched sibling transplantation for adults with B-cell acute lymphoblastic leukemia in complete remission: superior OS for patients with long-term survival

Guangyu Sun et al. Stem Cell Res Ther. .

Abstract

Background: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an important curative therapy for adult acute lymphoblastic leukemia (ALL). For patients who lack a human leukocyte antigen (HLA)-matched sibling donor, unrelated cord blood (UCB) is an alternative graft option. Previous studies have focused mainly on all T- and B-cell ALL (B-ALL) patients, while data related specifically to adult B-ALL patients after UCB transplantation (UCBT) are scarce.

Methods: We retrospectively compared the outcomes of UCBT and HLA-matched sibling transplantation (MST) in the treatment of adult B-ALL patients in complete remission (CR) at our center. From June 2006 to December 2020, 156 adult B-ALL patients who achieved CR before transplantation were enrolled. The main clinical outcomes of UCBT and MST were analyzed.

Results: Hematopoietic recovery was significantly faster in MST recipients than in UCBT recipients. Higher incidences of grades II-IV and III-IV acute graft-versus host disease (aGVHD) were found in UCBT recipients (P < 0.001 and = 0.03), while a lower incidence of extensive chronic GVHD (cGVHD) was found in UCBT recipients (P < 0.001). The cumulative incidences of 2-year non-relapse mortality (NRM), 2-year relapse, 5-year disease-free survival (DFS) and 5-year GVHD-free relapse-free survival (GRFS) were comparable between MST and UCBT recipients. The overall survival (OS) during the first 700 days was similar between the MST and UCBT groups, while the OS of patients with a survival time of more than 700 days in the UCBT group was better than that in the MST group according to multivariate analysis (P = 0.03).

Conclusions: Our study shows that when treating adult B-ALL patients in CR, UCBT can achieve comparable effects as MST, may provide superior OS for patients with long-term survival, and should be considered a good alternative.

Keywords: Acute lymphoblastic leukemia; Hematopoietic stem cell transplantation; Matched sibling transplantation; Unrelated cord blood transplantation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient enrollment in the study
Fig. 2
Fig. 2
Cumulative incidence of neutrophil engraftment (A) platelet engraftment (B), II–IV aGVHD (C),III–IV aGVHD (D), extensive cGVHD (E) and NRM (F) in the UCBT and MST group
Fig. 3
Fig. 3
OS (A), DFS (B), GRFS (C) and landmark analysis of OS (D) between UCBT and MST group
See this image and copyright information in PMC

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