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Reduced Intensity Allogeneic Hematopoietic Cell Transplantation in Older Patients With Acute Myeloid Leukemia and Myelodysplastic Syndromes: Comparable Outcomes With Unrelated Umbilical Cord Blood and HLA-Identical Sibling Donors

Year: 2011

Type: article

Abstract: Reduced-intensity conditioning (RIC) regimens allow allogeneic hematopoietic cell transplantation (HCT) in older patients with acceptable risks of treatment related mortality (TRM). Umbilical cord blood (UCB) has increased access to HCT for patients who do not have HLA-matched sibling donors (MSD). In this single institution study, we prospectively collected data on 98 consecutive patients (UCB = 60, MSD = 38) aged ≥ 55 years who received a RIC HCT for acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS) between 2001 and 2009. All patients received HCT using RIC regimen because of their older age. All patients received cyclophosphamide, fludarabine and 200 cGy total body irradiation as conditioning and cyclosporine and mycophenolate mofetil as prophylaxis against graft-versus-host-disease (GVHD) (Brunstein et al, Blood 2007). Median age at HCT for UCB recipients was 61 (range, 55-70) years and for MSD recipients was 63 (range, 56-70) years. There was no difference in transplant year, CMV status, cytogenetic risk, disease status and HCT-comorbidity index (HCT-CI) scores between UCB and MSD cohorts. Among UCB recipients, 95% received HCT using two UCB units and 88% received 4/6 or 5/6 HLA matched units; the median cryopreserved nucleated cell dose was 3.6 × 107 NC/kg. Overall survival at 3-years after HCT was 31% (95% CI, 19-44) for UCB and 37% (19-55) for MSD recipients (P = 0.21). The 2-year cumulative incidence of relapse was 47% and 34% (P = 0.19) and TRM was 25% and 25% (P = 0.82), respectively. The cumulative incidence of acute GVHD (grades 2-4) for UCB and MSD recipients was 45% and 38% (P = 0.19) and that for chronic GVHD at 2-years was 33% and 61% (P = 0.04), respectively. In multivariate analyses, donor source had no impact on overall survival, leukemia free survival, relapse or TRM (Table). In conclusion, RIC HCT using UCB is an acceptable alternative for older patients without a suitable MSD.Table 1Multivariate analysis of donor source and outcomes of RIC HCT using UCB and MSD in patients ≥55 yearsOutcomes*Adjusted for disease status and HCT-CI scoreMSD, N=38 (referent)UCB, N=60 (relative risk [95% CI])P-valueOverall survival1.01.3 (0.8-2.3)0.34Leukemia free survival1.01.2 (0.7-2.1)0.44Relapse1.00.7 (0.3-1.3)0.23TRM1.01.2 (0.6-2.7)0.61∗ Adjusted for disease status and HCT-CI score Open table in a new tab

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2010.12.015