The best donor option for acute myeloid leukemia (AML) patients lacking an HLA-matched donor has remained intensively debated. We herein report the results of a large retrospective registry study comparing hematopoietic cell transplantation (HCT) outcomes between double-unit umbilical cord blood transplantation (dCBT, n = 209) versus 9/10 HLA-matched unrelated donor (UD) with posttransplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis (UD 9/10, n = 270) in patients with AML in first complete remission (CR1). Inclusion criteria consisted of adult patient, AML in CR1 at transplantation, either peripheral blood stem cells (PBSC) from UD 9/10 with PTCy as GVHD prophylaxis or dCBT without PTCy, transplantation between 2013 and 2021, and no in vivo T-cell depletion. The 180-day cumulative incidence of grade II-IV acute GVHD was 29% in UD 9/10 versus 44% in dCBT recipients (p =.001). After adjustment for covariates, dCBT recipients had a higher non-relapse mortality (HR = 2.35, 95% CI: 1.23–4.48; p =.01), comparable relapse incidence (HR = 1.12, 95% CI: 0.67–1.86; p =.66), lower leukemia-free survival (HR = 1.5, 95% CI: 1.01–2.23; p =.047), and lower overall survival (HR = 1.66, 95% CI: 1.08–2.55; p =.02) compared with patients receiving UD 9/10 HCT. In summary, our results suggest that transplantation outcomes are better with UD 9/10 with PTCy-based GVHD prophylaxis than with dCBT for AML patients in CR1. These data might support the use of UD 9/10 with PTCy-based GVHD prophylaxis over dCBT in AML patients lacking an HLA-matched donor.
Higher survival following transplantation with a mismatched unrelated donor with posttransplant cyclophosphamide‐based graft‐versus‐host disease prophylaxis than with double unit umbilical cord blood in patients with acute myeloid leukemia in first complete remission: A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation / Baron, Frédéric; Labopin, Myriam; Versluis, Jurjen; Vydra, Jan; von dem Borne, Peter A.; Nicholson, Emma; Blaise, Didier; Protheroe, Rachel; Kulagin, Alexander; Bulabois, Claude Eric; Rovira, Montserrat; Chevallier, Patrice; Forcade, Edouard; Byrne, Jenny; Sanz, Jaime; Ruggeri, Annalisa; Mohty, Mohamad; Ciceri, Fabio. - In: AMERICAN JOURNAL OF HEMATOLOGY. - ISSN 0361-8609. - 99:12(2024), pp. 2296-2305. [10.1002/ajh.27466]
Higher survival following transplantation with a mismatched unrelated donor with posttransplant cyclophosphamide‐based graft‐versus‐host disease prophylaxis than with double unit umbilical cord blood in patients with acute myeloid leukemia in first complete remission: A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation
Ciceri, Fabio
2024-01-01
Abstract
The best donor option for acute myeloid leukemia (AML) patients lacking an HLA-matched donor has remained intensively debated. We herein report the results of a large retrospective registry study comparing hematopoietic cell transplantation (HCT) outcomes between double-unit umbilical cord blood transplantation (dCBT, n = 209) versus 9/10 HLA-matched unrelated donor (UD) with posttransplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis (UD 9/10, n = 270) in patients with AML in first complete remission (CR1). Inclusion criteria consisted of adult patient, AML in CR1 at transplantation, either peripheral blood stem cells (PBSC) from UD 9/10 with PTCy as GVHD prophylaxis or dCBT without PTCy, transplantation between 2013 and 2021, and no in vivo T-cell depletion. The 180-day cumulative incidence of grade II-IV acute GVHD was 29% in UD 9/10 versus 44% in dCBT recipients (p =.001). After adjustment for covariates, dCBT recipients had a higher non-relapse mortality (HR = 2.35, 95% CI: 1.23–4.48; p =.01), comparable relapse incidence (HR = 1.12, 95% CI: 0.67–1.86; p =.66), lower leukemia-free survival (HR = 1.5, 95% CI: 1.01–2.23; p =.047), and lower overall survival (HR = 1.66, 95% CI: 1.08–2.55; p =.02) compared with patients receiving UD 9/10 HCT. In summary, our results suggest that transplantation outcomes are better with UD 9/10 with PTCy-based GVHD prophylaxis than with dCBT for AML patients in CR1. These data might support the use of UD 9/10 with PTCy-based GVHD prophylaxis over dCBT in AML patients lacking an HLA-matched donor.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
