Outcomes after Umbilical Cord Blood Transplantation for Myelodysplastic Syndromes

Year: 2017

Type: article

Abstract: For patients with hematologic malignancies undergoing allogeneic hematopoietic cell transplantation, umbilical cord blood transplantation (UCBT) has become an acceptable alternative donor source in the absence of a matched sibling or unrelated donor. To date, however, there have been few published series dedicated solely to describing the outcomes of adult patients with myelodysplastic syndrome (MDS) who have undergone UCBT. Between 2004 and 2013, 176 adults with MDS underwent UCBT as reported to the Center for International Blood and Marrow Transplant Research. Median age at the time of transplantation was 56 years (range, 18-73 years). The study group included 10% with very low, 23% with low, 19% with intermediate, 19% with high, and 13% with very high-risk Revised International Prognostic Scoring System (IPSS-R) scores. The 100-day probability of grade II-IV acute graft-versus-host disease (GVHD) was 38%, and the 3-year probability of chronic GVHD was 28%. The probabilities of relapse and transplantation-related mortality (TRM) at 3 years were 32% and 40%, respectively, leading to a 3-year disease-free survival (DFS) of 28% and an overall survival (OS) of 31%. In multivariate analysis, increasing IPSS-R score at the time of HCT was associated with inferior TRM (P = .0056), DFS (P = .018), and OS (P = .0082), but not with GVHD or relapse. The presence of pretransplantation comorbidities was associated with TRM (P = .001), DFS (P = .02), and OS (P = .001). Reduced-intensity conditioning was associated with increased risk of relapse (relative risk, 3.95; 95% confidence interval, 1.78-8.75; P < .001), and although a higher proportion of myeloablative UCBTs were performed in patients with high-risk disease, the effect of conditioning regimen intensity was the same regardless of IPSS-R score. For some individuals who lack a matched sibling or unrelated donor, UCBT can result in long-term DFS; however, the success of UCBT in this population is hampered by a high rate of TRM.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2017.03.014

Institutions: Cleveland Clinic, Medical College of Wisconsin, University of Southern California, Children's Hospital Los Angeles, Rush University Medical Center, King Faisal Specialist Hospital & Research Centre, Massachusetts General Hospital, University of Miami, University Hospital of Bern, University Cancer Center Hamburg, Centre Hospitalier Universitaire de Grenoble, Dana-Farber Cancer Institute, Imperial College London, NewYork–Presbyterian Hospital, Weill Cornell Medical Center, Levine Cancer Institute, Johns Hopkins All Children's Hospital, Vanderbilt University Medical Center, Baylor College of Medicine, University of Virginia Health System, University of Virginia Medical Center, Moffitt Cancer Center, Uppsala University, Karolinska Institutet, UMass Memorial Medical Center, University of Alabama at Birmingham, Northside Hospital, University of Minnesota Medical Center, Vall d'Hebron Hospital Universitari, Seattle Cancer Care Alliance, The University of Texas MD Anderson Cancer Center

Language: English

Topic: Hematopoietic Stem Cell Transplantation

Subfield: Hematology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,650

Funders: U.S. Department of Defense, U.S. Department of Health and Human Services, Amgen, Gilead Sciences, Health Research, Government of South Australia, National Institutes of Health, Health Resources and Services Administration, U.S. Navy, National Heart, Lung, and Blood Institute, Office of Naval Research, National Cancer Institute, National Institute of Allergy and Infectious Diseases

Awards: G1515501300, G4298420724, G7160503914, Blood & Marrow Transplant Clinical Trials Network Data Coordinating Center, A Data Resource for Blood and Marrow Transplants and Adoptive Cellular Therapy Research

OpenAlex ID: W2591670358