Prospective Randomized Study Comparing Myeloablative Unrelated Umbilical Cord Blood Transplantation versus HLA-Haploidentical Related Stem Cell Transplantation for Adults with Hematologic Malignancies

Sanz, Jaime; Montoro, Juan; Solano, Carlos; Valcárcel, David; Sampol, Antònia; Ferrà, Christelle; Parody, Rocío; Lorenzo, Ignacio; Montesinos, Pau; Ortí, Guillermo; Hernández‐Boluda, Juan Carlos; Balaguer‐Roselló, Aitana; Guerreiro, Manuel; Carretero, Carlos; Sanz, Guillermo; Sanz, Miguel Á.; Piñana, José Luís

doi:10.1016/j.bbmt.2019.10.014

Cited by 44 publications

(35 citation statements)

References 44 publications

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“…Two-year NRM and relapse in the two arms were 52% versus 23% and 17% versus 23%, respectively. Two-year DFS, OS, and GVHD/RFS in the two arms were 30% versus 54%, 35% versus 59%, and 17% versus 40%, respectively, indicating that in the context of an MAC regimen, Haplo-SCT with PTCy provides improved outcomes compared with ATG-containing single-unit UCBT 26 . A retrospective single-institutional study by Raiola et al 31 revealed that despite having more patients older than 50 (40% versus 23%) and with advanced disease (58% versus 41%), Haplo SCT using PTCy and bone marrow had superior 3-year NRM (18% versus 35%) and 4-year OS (52% versus 34%) than single-unit UCBT.…”

Section: Discussionmentioning

confidence: 94%

“…A total of 37 articles underwent full-length review; 23 of them were excluded because they only evaluated patients receiving either Haplo-SCT, UCBT, or combined Haplo-SCT and UCBT, nonhematologic cancers, and lack of direct comparison results; 2 articles were excluded due to insufficient data. The final analysis included 12 studies including 2 prospective clinical studies 25,26 and 10 retrospective cohort studies [27][28][29][30][31][32][33][34][35][36] . This included 2,793 patients who underwent Haplo-SCT (1,432 patients) or UCBT (1,361 patients).…”

Section: General Description Of Included Studiesmentioning

confidence: 99%

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Haploidentical Hematopoietic Stem Cell Transplantation Versus Umbilical Cord Blood Transplantation in Hematologic Malignancies: A Systematic Review and Meta-Analysis

2020

Cell Transplant

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Haploidentical hematopoietic stem cell transplantation (Haplo-SCT) and umbilical cord blood transplantation (UCBT) are two important alternatives when a matched sibling donor is unavailable. Several studies have reported inconsistent clinical outcomes comparing Haplo-SCT and UCBT. Therefore, it is necessary to synthesize the existing evidence regarding outcomes of stem cell transplantations comparing Haplo-SCT with UCBT. We searched article titles that compared transplantation with Haplo-SCT and UCBT in MEDLINE (PubMed), Cochrane library, and EMBASE database. To compare clinical outcomes between Haplo-SCT and UCBT, we performed a meta-analysis of 12 studies and reported the pooled odds ratios (ORs) of 6 end points including overall survival (OS), progression-free survival (PFS), nonrelapse mortality (NRM), relapse rate (RR), acute graft-versus-host disease (aGVHD), and chronic graft-versus-host disease (cGVHD). We found that Haplo-SCT was associated with a significantly superior OS (pooled OR of 0.74, 95% confidence interval [CI] 0.68 to 0.80) and PFS (0.77, 95% CI 0.72 to 0.83), as well as a lower NRM (0.72, 95% CI 0.64 to 0.80) and aGVHD (0.87, 95% CI 0.77 to 0.98) compared to the UCBT group. We also found a significantly increased risk of cGVHD in Haplo-SCT group (1.40, 95% CI 1.22 to 1.62). In terms of RR, Haplo-SCT was comparable to UCBT (0.91, 95% CI 0.79 to 1.05). Results of this meta-analysis demonstrate that Haplo-SCT results in better clinical outcomes compared to UCBT in terms of OS, PFS, TRM, and aGVHD, but is inferior to UCBT in terms of increased cGVHD risk. Further prospective comparisons between Haplo-SCT and UCBT are needed.

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Section: Discussionmentioning

confidence: 94%

Section: General Description Of Included Studiesmentioning

confidence: 99%

Haploidentical Hematopoietic Stem Cell Transplantation Versus Umbilical Cord Blood Transplantation in Hematologic Malignancies: A Systematic Review and Meta-Analysis

2020

Cell Transplant

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“…In contrast, two recent report from Europe on patients with acute leukemia who received a thiotepa-containing non-irradiation containing myeloablative regimen found higher survival after haplo compared to UCB HSCT. 30,31 We examined carefully for a transplant center on survival and found none. Thus, the available data support using haplo-or UCB as alternate donor sources to increase access to HSCT when an HLA-matched relative or unrelated adult donor is not available.…”

Section: Discussionmentioning

confidence: 99%

Comparison of haploidentical and umbilical cord blood transplantation after myeloablative conditioning

Wagner

Ballen

Zhang³

et al. 2021

Blood Advances

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Haploidentical hematopoietic stem cell transplantation (haplo HSCT) has emerged as an important treatment modality. Most reports comparing haplo HSCT with post-transplant cyclophosphamide (PTCy) and other donor sources have focused on outcomes in older adults treated with reduced intensity conditioning. Therefore, in the current study, we evaluated outcomes in patients with hematological malignancy treated with myeloablative conditioning prior to haplo (n=375) or umbilical cord blood (UCB, n=333) HSCT. All haplo recipients received a 4 of 8 HLA matched graft while recipients of UCB were matched at 6-8/8 (n=145) or ≤5/8 (n=188) HLA antigens. Recipients of 6-8/8 UCB transplants were younger (14 years vs. 21 and 29 years) and more likely to have lower co-morbidity scores compared to recipients of ≤5/8 UCB and haplo HSCT (81% vs. 69% and 63%, respectively). UCB recipients were more likely to have acute lymphoblastic leukemia and transplanted in second complete remission (CR) whereas haplo HSCT recipients were more likely to have acute myeloid leukemia in first CR. Other characteristics, including cytogenetic risk were similar. Survival at 3 years was similar for the donor sources (66% haplo and 61% after ≤5/8 and 58% after 6-8/8 UCB). Notably, relapse at 3 years was lower in recipients of ≤5/8 UCB (21%, p=0.03) compared to haplo (36%) and 6-8/8 UCB (30%). However, non-relapse mortality was higher in ≤5/8 UCB (21%) compared to other groups (p<0.0001). These data suggest that haplo HSCT with PTCy after myeloablative conditioning provides an overall survival outcome comparable to that after UCB regardless HLA match group.

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“…In contrast, two recent prospective, randomized trials indicated better outcomes with HLA-haploidentical grafts compared to UCB transplants. 111,112 However, relapse has remained a major complication, as half of the patients relapsed two years after transplant in both studies, regardless of conditioning regimen intensity. Additional controlled comparisons of the two donor sources may be needed to validate the superiority of HLA-haploidentical over UCB grafts.…”

Section: Current Trendsmentioning

confidence: 99%

History of hematopoietic cell transplantation: challenges and progress

Granot

Storb

2020

haematol

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After more than 60 years of research in allogeneic hematopoietic cell transplantation (HCT), this therapy has advanced from one that was declared dead in the 1960s to a standard treatment of otherwise fatal malignant and non-malignant blood diseases. To date, close to 1.5 million hematopoietic cell transplants have been performed in more than 1,500 transplantation centers worldwide. This review will highlight the enormous efforts by numerous investigators throughout the world who have brought the experimental field of HCT to clinical reality, examine ongoing challenges, and provide insights for the future.

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Prospective Randomized Study Comparing Myeloablative Unrelated Umbilical Cord Blood Transplantation versus HLA-Haploidentical Related Stem Cell Transplantation for Adults with Hematologic Malignancies

Cited by 44 publications

References 44 publications

Haploidentical Hematopoietic Stem Cell Transplantation Versus Umbilical Cord Blood Transplantation in Hematologic Malignancies: A Systematic Review and Meta-Analysis

Haploidentical Hematopoietic Stem Cell Transplantation Versus Umbilical Cord Blood Transplantation in Hematologic Malignancies: A Systematic Review and Meta-Analysis

Comparison of haploidentical and umbilical cord blood transplantation after myeloablative conditioning

History of hematopoietic cell transplantation: challenges and progress

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