Similar survival, but better quality of life after myeloablative transplantation using unrelated cord blood vs matched sibling donors in adults with hematologic malignancies

Abstract

This study included data from 185 consecutively treated patients, 16 years of age or older, who underwent myeloablative transplantation using unrelated umbilical cord blood (UCB) (UCB transplantation (UCBT), n = 70) or HLA-identical sibling donor peripheral blood stem cells alone or combined with bone marrow (BMT/PBSCT, n = 115) from October 2001 to December 2012. All patients received myeloablative regimens, cyclosporin A plus mycophenolate mofetil as prophylaxis for GVHD, and similar supportive care. Although hematopoietic recovery was significantly delayed after UCBT, the rate of neutrophil engraftment was comparable. The median follow-up was 53 months (range, 15-136 months) for BMT/peripheral blood SCT (PBSCT) recipients and 35 months (range, 10-123 months) for UCBT recipients. There were no significant differences in the cumulative incidence of grades III to IV acute GVHD, relapse rate, or 3-year probabilities of disease-free survival between patients receiving UCBT and those receiving BMT/PBSCT. However, the cumulative incidence of chronic and extensive chronic GVHD was lower in UCBT recipients. The rates of long-term survivors returning to school or work and off immunosuppressive therapy were significantly higher after UCBT, which indicated that long-term survivors who underwent UCBT had a higher quality of life.

Comparison of transplant outcomes from matched sibling bone marrow or peripheral blood stem cell and unrelated cord blood in patients 50 years or older

“…In addition, several recent studies demonstrated highly similar survival results between CBT and MSD recipients [12][13][14]27,45,46]. However, in this study, the rate of OS after CBT was significantly inferior to that after BMT or PBSCT from MSDs.…”

“…Since the lower incidence of severe GVHD is one of the advantages of CBT [8,10,11,26,27], the higher incidence of GVHD using older MSDs could be overcome using CB for older patients. In addition, the absence of risk to donors may also be advantageous with CBT because the risk of adverse events during donation increases with the age of the donor [26].…”

Better outcomes of modified myeloablative conditioning without antithymocyte globulin versus myeloablative conditioning in cord blood transplantation for hematological malignancies: A retrospective (development) and a prospective (validation) study

“…Furthermore, our previous study showed that long-term survivors with CBT had less cGVHD and higher quality of life compared to HCT in HLA-identical sibling's donors. 47 Thus, our protocol of MMAC without ATG not only makes full use of the GVL effects of CBT but also keeps its advantage of low probability of cGVHD.…”

Clinical separation of cGvHD and GvL and better GvHD-free/relapse-free survival (GRFS) after unrelated cord blood transplantation for AML

“…New strategies should be further investigated to improve the antileukemic effect after CBT. We have reported that myeloablative CBT can result in improved survival and decreased relapse rates in adult or pediatric recipients with hematologic malignancies 3,4 compared with transplants from HLA-matched sibling donors (MSD); however, few studies have presented a comparative analysis of myeloablative CBT and allo-HCT from MSD for AML in a disease-specific manner. GvHD-free and relapse-free survival (GRFS) is a novel composite end point of allo-HCT, and takes into account severe acute GvHD (aGvHD), extensive chronic GvHD (cGvHD), TRM and relapse, and represents real recovery after allo-HCT.…”