Comparison of Outcomes of 8/8 and 7/8 Allele–Matched Unrelated Bone Marrow Transplantation and Single-Unit Cord Blood Transplantation in Adults with Acute Leukemia

Abstract

To investigate an up-to-date alternative donor selection strategy, we compared the transplantation outcomes of 8/8 and 7/8 allele-matched unrelated bone marrow transplantation (UBMT) with those of umbilical cord blood transplantation (UCBT) and redefined the role of UCBT with extended analysis. Using Cox and competing risk regression analyses, we analyzed the transplantation outcomes in adult patients with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). A total of 2472 first myeloablative transplantations between 2000 and 2010 were included (8/8 UBMT, 1001; 7/8 UBMT, 656; UCBT, 815). For acute and chronic graft-versus-host disease (GVHD) and nonrelapse mortality (NRM), we applied the combined analyses including both AML and ALL data. In the multivariate analyses, severe acute GVHD and NRM after UCBT were comparable with 8/8 UBMT, whereas those after 7/8 UBMT were significantly higher. The incidence of extensive chronic GVHD was significantly lower with UCBT compared with after 8/8 and 7/8 UBMT. With adjusted analyses for AML, UCBT and 8/8 UBMT showed similar overall survival (OS), whereas 7/8 UBMT showed inferior OS. For ALL, we found no significant difference in OS among the 3 groups. Cord blood may be the first choice alternative to 8/8 UBMT for both AML and ALL.

Allogeneic haematopoietic cell transplantation for adult acute myeloid leukaemia in second remission: a retrospective study of the Adult Acute Myeloid Leukaemia Working Group of the Japan Society for Haematopoietic Cell Transplantation (JSHCT)

“…Similar to previous reports (Burnett et al , ; Michelis et al , , ), our data also demonstrated that donor source did not affect transplant outcomes in CR2, except that unrelated cord blood transplantation (UCBT) gave a higher TRM in the univariate analysis. However, several studies have demonstrated highly similar survival results between UCBT and UBMT in adult AML (Terakura et al , ). In addition, our data demonstrated that the intensity of the conditioning regimen did not affect survival, relapse and TRM in CR2, which is consistent with previous studies (Burnett et al , ; Michelis et al , , , ).…”

Milestones of Hematopoietic Stem Cell Transplantation – From First Human Studies to Current Developments

“…Others observed similar rates of severe acute GvHD after CBT and 8/8 matched BMT but higher rates after 7/8 matched BM grafting while the incidence of extensive chronic GvHD was significantly lower after CBT compared with 8/8 and 7/8 BM grafting (178). …”

“…More recent studies support these results (143, 177), respectively. Terakura and colleagues analyzing HSCT outcomes in patients with ALL and AML reported similar OS and NRM comparing 8/8 allele-matched unrelated BMT with CBT leading to the conclusion that CB could be a preferable alternative (178). …”

Mismatched unrelated donor transplantation

“…16 This analysis included 2472 myeloablative transplants (1001 HLA 8/8; 656 HLA 7/8; 815 cord blood transplants). Overall, recipients of HLA 7/8 matched unrelated donor transplantation had lower overall survival, higher GVHD and higher non-relapse mortality compared to HLA 8/8 matched unrelated and cord blood transplant recipients.…”