Comparison of long-term outcome for AML patients alive free of disease 2 years after allogeneic hematopoietic cell transplantation with umbilical cord blood versus unrelated donor: a study from the ALWP of the EBMT

Abstract

Since cord blood transplantation (CBT) has been associated with high graft-versus-leukemia effects and a low incidence of chronic graft-versus-host disease (GVHD), we hypothesized that long-term outcomes might be better in CBT patients than in those given grafts from unrelated donors (UD). Therefore, we performed a landmark study comparing long-term outcomes in acute myeloid leukemia (AML) patients alive and disease-free 2 years after transplantation who received grafts from either CBT or UD. A total of 364 CBT recipients, 2648 UD 10/10 patients and 681 patients given grafts from UD 9/10 were included. Median follow-up was 6.0 years. Five-year leukemia-free survival (LFS) from transplantation was 86% in CBT patients, 84% in UD 10/10 patients (P = 0.36) and 84% in UD 9/10 patients (P = 0.86). On multivariate analysis, donor type had no impact on LFS. Similarly, no impact of donor type was observed on relapse incidence or non-relapse mortality. Factors associated with poorer LFS on multivariate analysis included higher age at transplantation (P < 0.001), male gender (P < 0.001), second complete remission (CR2) versus CR1 (P = 0.05), secondary AML (P = 0.01), antecedent of chronic GVHD (P < 0.001) and poor-risk cytogenetics (P = 0.01). In conclusion, our study shows that long-term outcome for AML patients in CR two years after transplantation is not impacted by donor type.

Comparison of HLA-mismatched unrelated donor transplantation with post-transplant cyclophosphamide versus HLA-haploidentical transplantation in patients with active acute myeloid leukemia

“…One could speculate that transplantation approaches with the highest graft-versus-leukemia (GvL) potential should be used in patients with active AML at transplantation. However, although previously associated with high GvL effects [10][11][12][13], transplantation outcomes were inferior with umbilical cord blood transplantation (CBT) than with unrelated donor allo-HCT [7]. Other studies have observed similar outcomes with HLA-matched sibling and HLA-matched unrelated donor [8], but lower survival following Haplo-HCT (including both T-cell depleted and T-cell repleted transplants) than with allo-HCT with an HLA-matched sibling donor [9].…”

A new beginning: can omidubicel emerge as the next, viable alternative donor source?

“…While this is an excellent demonstration of robust GVL effect from UCB, two retrospective EBMT studies and the available prospective, randomized clinical trials have not confirmed that UCB grafts are superior to matched or mismatched URD grafts for relapse control. 35 , 36 It is also important to remember UCB allograft recipients will lack future options for donor lymphocyte infusions in the event of post-allogeneic HCT relapse.…”