Risk factors for outcomes after unrelated cord blood transplantation for adults with acute lymphoblastic leukemia: a report on behalf of Eurocord and the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation

Tucunduva, Luciana; Ruggeri, Annalisa; Sanz, Guillermo; Fürst, Sabine; Socié, Gèrard; Michallet, Mauricette; Arcese, William; Milpied, Noël; Yakoub-Agha, Ibrahim; Linkesch, Werner; Cornelissen, Jan J.; Mannone, Lionel; Iori, Anna Paola; Ribera, Josep‐Marǐa; Sanz, Jaime; Montesinos, Pau; Purtill, Duncan; Labopin, Myriam; Gluckman, Éliane; Mohty, Mohamad; Rocha, Vanderson

doi:10.1038/bmt.2014.72

Cited by 21 publications

(12 citation statements)

References 34 publications

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“…However ATG had no impact either on relapse incidence, in agreement with recent observations in the PBSC transplantation setting [29, 30]. Further, as previously observed in the UCB setting [5, 11], older age was associated with worse LFS and OS.…”

Section: Discussionsupporting

confidence: 90%

RIC versus MAC UCBT in adults with AML: A report from Eurocord, the ALWP and the CTIWP of the EBMT

et al. 2016

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Nonrelapse mortality (NRM) is the first cause of treatment failure after unrelated cord blood transplantation (UCBT) following myeloablative conditioning (MAC). In the last decade, reduced-intensity conditioning (RIC) regimens have been developed with the aim of reducing NRM and allowing older patients and those with medical comorbidities to benefit from UCBT. The aim of the current retrospective study was to compare transplantation outcomes of acute myeloid leukemia (AML) patients given UCBT after either RIC or MAC. Data from 894 adults with AML receiving a single or double UCBT as first allograft from 2004 to 2013 at EBMT centers were included in this study. 415 patients were given UCBT after RIC while 479 patients following a MAC. In comparison to MAC recipients, RIC recipients had a similar incidence of neutrophil engraftment and of acute and chronic graft-versus-host disease (GVHD). However, RIC recipients had a higher incidence of disease relapse and a lower NRM, translating to comparable leukemia-free (LFS), GVHD-free, relapse-free survival (GRFS) and overall survival (OS). These observations remained qualitatively similar after adjusting for differences between groups in multivariate analyses. In conclusion, these data suggest that LFS and OS are similar with RIC or with MAC in adults AML patients transplanted with UCBT. These observations could serve as basis for a future prospective randomized study.

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Section: Discussionsupporting

confidence: 90%

RIC versus MAC UCBT in adults with AML: A report from Eurocord, the ALWP and the CTIWP of the EBMT

et al. 2016

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“…Consistent with previous reports [15,16], our study underscores the prognostic importance of leukemia remission status at the time of transplantation, with OS, LFS, and RI adversely affected in the patients not in CR1. Thus, appropriate selection of patients for alloHCT in CR1 remains critical to improving transplantation outcomes.…”

Section: Discussionsupporting

confidence: 92%

Cytogenetics Does Not Impact Outcomes in Adult Patients with Acute Lymphoblastic Leukemia Undergoing Allogeneic Hematopoietic Cell Transplantation

Aldoss

Tsai

Slovak³

et al. 2016

Biology of Blood and Marrow Transplantation

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The prognostic relevance of cytogenetics at diagnosis on the outcome of allogeneic hematopoietic stem cell transplantation (alloHCT) for adult acute lymphoblastic leukemia (ALL) remains unclear. We retrospectively analyzed outcomes of 333 adult ALL patients who underwent alloHCT at our institution over a 10-year period. Patients were classified according to disease status at transplantation (complete response [CR] 1 [n = 202] or > CR1) and according to cytogenetic risk, defined as good (2%), intermediate (42%), poor (46%), or unknown (10%) based on available outcome data for each of the cytogenetic abnormalities. Three-year overall survival (OS), leukemia-free survival (LFS), and relapse incidence (RI) were 55.7%, 47.9% and 27.5%, respectively; 1-year nonrelapse mortality (NRM) was 17.3%. For patients undergoing alloHCT in CR1, 3-year OS, LFS, and RI were 69.8%, 62.3%, and 17.1%, respectively. In multivariable analysis, cytogenetic risk did not impact OS or LFS for the whole cohort or for patients who underwent transplantation in CR1. Disease status at alloHCT was an independent predictor for LFS (CR1 versus others: hazard ratio [HR], 3.17; P < .01) and OS (CR1 versus others: HR, 2.90; P < .01). Graft-versus-host disease prophylaxis with tacrolimus/sirolimus was associated with a low NRM of 11.5% in the alloHCT recipients in CR1. Our data indicate that cytogenetic risk is not an independent predictor of outcomes in alloHCT performed to treat adult ALL.

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“…Single center and registry retrospective series are also emerging reporting disease-specific outcomes in patients with acute myelogenous leukemia (AML) 11, 12 , acute lymphoblastic leukemia 13,14 , myelodysplasia 15 , myelofibrosis 16,17 , non-Hodgkins or Hodgkin lymphoma 18–20 , and multiple myeloma 21,22 . In addition, a number of prospective studies have now been reported.…”

Section: Introductionmentioning

confidence: 99%

Optimal Practices in Unrelated Donor Cord Blood Transplantation for Hematologic Malignancies

Barker

Kurtzberg

Ballen

et al. 2017

Biology of Blood and Marrow Transplantation

123

115

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Unrelated donor cord blood (CB) transplantation (CBT) results in disease-free survival comparable to that of unrelated adult donor transplantation in patients with hematologic malignancies. Extension of allograft access to racial and ethnic minorities, rapid graft availability, flexibility of transplant date, and low risks of disabling chronic graft-versus-host disease (GVHD) and relapse are significant advantages of CBT, and multiple series have reported a low risk of late transplant-related mortality (TRM) post-transplant. Nonetheless, early post-transplant morbidity and TRM and the requirement for intensive early post-transplant management have slowed wide adoption of CBT. Targeted care strategies in CBT recipients can, however, mitigate early transplant complications and reduce transplant costs. Herein, we provide a practical “how to” guide to CBT for hematologic malignancies on behalf of the NMDP and the ASBMT CB Special Interest Group (SIG). It shares the best practices of 6 experienced United States transplant centers with a special interest in the use of CB as a hematopoietic stem cell source. We address donor search and unit selection, unit thaw and infusion, conditioning regimens, immune suppression, management of GVHD, opportunistic infections and other factors in supportive care appropriate for CBT. Meticulous attention to such details has improved CBT outcomes and will facilitate the success of CBT as a platform for future graft manipulations.

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Risk factors for outcomes after unrelated cord blood transplantation for adults with acute lymphoblastic leukemia: a report on behalf of Eurocord and the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation

Cited by 21 publications

References 34 publications

RIC versus MAC UCBT in adults with AML: A report from Eurocord, the ALWP and the CTIWP of the EBMT

RIC versus MAC UCBT in adults with AML: A report from Eurocord, the ALWP and the CTIWP of the EBMT

Cytogenetics Does Not Impact Outcomes in Adult Patients with Acute Lymphoblastic Leukemia Undergoing Allogeneic Hematopoietic Cell Transplantation

Optimal Practices in Unrelated Donor Cord Blood Transplantation for Hematologic Malignancies

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