Allogeneic hematopoietic cell transplantation with cord blood versus mismatched unrelated donor with post-transplant cyclophosphamide in acute myeloid leukemia

Journal of Hematology & Oncology

Frederic Baron¹  Arnon Nagler²  Patrice Chevallier³  Jürgen Kuball⁴  Jan Cornelissen⁵  Bipin N. Savani⁶  Bhagirathbhai Dholaria⁶  Annalisa Ruggeri⁷  Patrice Ceballos⁸  Myriam Labopin⁹  Mohamad Mohty^1,10  Jaime Sanz^1,11  Anna Grassi^1,12  Edouard Forcade^1,13  Hélène Labussière-Wallet^1,14  Fabio Ciceri^1,15  Didier Blaise^1,16  Ludmila Zubarovskaya^1,17 

[1] CHU and University of Liège, Liège, Belgium;Chaim Sheba Medical Center, Tel Hashomer, Israel;ALWP Office Hôpital Saint-Antoine, Paris, France;Department of D’Hematologie, CHU Nantes, Nantes, France;Department of Haematology, University Medical Centre, Utrecht, The Netherlands;Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands;Department of Hematology-Oncology, Vanderbilt University Medical Center, 220 Pierce Ave, 777 Preston Research Building, 37232, Nashville, TN, USA;Department of Pediatric Hematology and Oncology IRCCS, Ospedale Pediatrico Bambino Gesù, Rome, Italy;Département d’Hématologie Clinique, CHU Lapeyronie, Montpellier, France;EBMT ALWP Office, Hôpital Saint-Antoine, Paris, France;EBMT ALWP Office, Hôpital Saint-Antoine, Paris, France;Service d’Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, UMRs 938, AP-HP, Sorbonne University, and INSERM, Paris, France;Hematology Department, University Hospital La Fe, Valencia, Spain;Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy;Hôpital Haut-Leveque, CHU Bordeaux, Pessac, France;Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France;Ospedale San Raffaele S.R.L., Haematology and BMT, Milan, Italy;Programme de Transplantation and Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France;RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russian Federation;

关键词: Mismatched donor;    Cord blood transplantation;    Cord blood unit;    Acute leukemia;    Acute myeloid leukemia;    Toxicity;    Graft-versus-host disease;    Disease relapse;    Allogeneic hematopoietic cell transplantation;    Peripheral blood stem cell;    Bone marrow;    Post-transplant cyclophosphamide;    Human leukocyte antigen;   

DOI  :  10.1186/s13045-021-01086-2

来源: Springer

【 摘 要 】

BackgroundAllogeneic hematopoietic cell transplantation (allo-HCT) using a mismatched unrelated donor (MMUD) and cord blood transplantation (CBT) are valid alternatives for patients without a fully human leukocyte antigen (HLA)-matched donor. Here, we compared the allo-HCT outcomes of CBT versus single-allele-mismatched MMUD allo-HCT with post-transplant cyclophosphamide (PTCy) in acute myeloid leukemia.MethodsPatients who underwent a first CBT without PTCy (N = 902) or allo-HCT from a (HLA 9/10) MMUD with PTCy (N = 280) were included in the study. A multivariate regression analysis was performed for the whole population. A matched-pair analysis was carried out by propensity score-based 1:1 matching of patients (177 pairs) with known cytogenetic risk.ResultsThe incidence of grade II–IV and grade III–IV acute graft-versus-host disease (GVHD) at 6 months was 36% versus 32% (p = 0.07) and 15% versus 11% (p = 0.16) for CBT and MMUD cohorts, respectively. CBT was associated with a higher incidence of graft failure (11% vs. 4%, p < 0.01) and higher 2-year non-relapse mortality (NRM) (30% vs. 16%, p < 0.01) compared to MMUD. In the multivariate analysis, CBT was associated with a higher risk of, NRM (HR = 2.09, 95% CI 1.46–2.99, p < 0.0001), and relapse (HR = 1.35, 95% CI 1–1.83, p = 0.05), which resulted in worse leukemia-free survival (LFS) (HR = 1.68, 95% CI 1.34–2.12, p < 0.0001), overall survival (OS) (HR = 1.7, 95% CI 1.33–2.17, p < 0.0001), and GVHD-free, relapse-free survival (GRFS) (HR = 1.49, 95% CI 1.21–1.83, p < 0.0001) compared to MMUD. The risk of grade II–IV acute GVHD (p = 0.052) and chronic GVHD (p = 0.69) did not differ significantly between the cohorts. These results were confirmed in a matched-pair analysis.ConclusionsCBT was associated with lower LFS, OS, and GRFS due to higher NRM, compared to MMUD allo-HCT with PTCy. In the absence of a fully matched donor, 9/10 MMUD with PTCy may be preferred over CBT.

【 授权许可】

CC BY