Favorable Outcome of Unrelated Cord Blood Transplantation for Philadelphia Chromosome–Positive Acute Lymphoblastic Leukemia

Abstract

Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph(+)ALL) is one of the highest-risk ALL groups. Whenever possible, patients with Ph(+)ALL should undergo allogeneic hematopoietic stem cell transplantation (HSCT) after induction of remission. Although unrelated cord blood transplantation (CBT) has become a common treatment in adult patients who lack a sibling donor, data on the efficacy of CBT for Ph(+)ALL are limited. We analyzed the clinical outcomes of 20 Ph(+)ALL patients who underwent CBT (n = 8) or unrelated bone marrow transplantation (BMT) (n = 12). The median age was 41 years (range, 17-55 years). All but one of the patients were treated with an imatinib-based regimen before HSCT, and 19 patients were in first complete remission (CR) and 1 patient was in second CR at the time of HSCT. Seventeen patients received a myeloablative conditioning regimen containing 12 Gy of total-body irradiation, and 3 received a reduced-intensity conditioning regimen. After a median of 26 months of follow-up, estimated 3-year overall and leukemia-free survival rates were 100% and 85%, respectively, after CBT, and 49% and 38%, respectively, after unrelated BMT. The CBT group had significantly better overall survival than the BMT group (P = .02). Although BCR-ABL transcript was detected in 4 of 8 CBT patients at transplantation, 7 patients remained in molecular CR. Our findings suggest that CBT may be a viable option as postinduction therapy for Ph(+)ALL in patients lacking a sibling donor.

Impact of minimal residual disease on outcomes after umbilical cord blood transplantation for adults with Philadelphia-positive acute lymphoblastic leukaemia: an analysis on behalf of Eurocord, Cord Blood Committee and the Acute Leukaemia working party of

“…To date, allo‐HSCT in first complete remission (CR1) remains the treatment of choice for Ph+ALL (Fielding et al , ; Lee et al , ; Oliansky et al , ). Although the use of alternative stem cell sources, including unrelated umbilical cord blood transplantation (UCBT), is widespread among those patients lacking a human leucocyte antigen (HLA) matched donor, results on outcomes after UCBT for Ph+ALL are very scarce in the literature (Onishi et al , ; Piñana et al , ).…”

Myeloablative unrelated cord blood transplantation for Philadelphia chromosome-positive acute lymphoblastic leukemia: comparison with other graft sources from related and unrelated donors

“…Onishi et al compared CBT (n=8) and uBMT (n=12) in adult patients with Ph+ALL. The CBT group had significantly better OS than the uBMT group (P= 0.02) [19]. Piñana et al reported the results of 45 patients with Ph+ALL who received CBT after myeloablative busulfanbased conditioning.…”

Umbilical cord blood transplantation from unrelated donors in patients with Philadelphia chromosome-positive acute lymphoblastic leukemia

“…In fact, UCBT has been scarcely reported in patients with Ph + ALL. 10 Limited data are available in registry-based reports of UCBT outcomes in adults with ALL, [6][7][8]10,20,21 but these reports were mainly focused on comparing UCBT with bone marrow or peripheral blood allogeneic hematopoietic stem cell transplantation (HSCT). Although they included some patients with Ph + ALL, outcomes were not reported specifically for these patients.…”

“…In fact, as far as we know, only one pilot study of eight patients with Ph + ALL who underwent UCBT has been published so far. 10 We report here the outcome of a relatively large series of 45 patients with Ph + ALL who underwent busulfan-based myeloablative single-unit UCBT from unrelated donors. Apart from confirming the safety and efficacy of the procedure in this specific disease, an additional aim of the study was to identify variables influencing short-and long-term outcomes.…”