Optimizing Preparative Regimen for Umbilical Cord Blood Transplantation in Adult Acute Leukemia Patients: Acute Lymphoblastic Leukemia Requires Myeloablative Conditioning but Not Acute Myeloid Leukemia
Year: 2020
Type: article
Study design: Observational Study
Abstract: Cord blood transplantation (CBT) is a valuable alternative to bone marrow transplantation in adults without readily available donors. We conducted this study to investigate the feasibility of CBT for adult patients with acute leukemia with regards to impact of different conditioning and graft-versus-host disease (GVHD) prophylaxis regimens on clinical outcomes. From 16 centers in Korea, 41 acute myeloid leukemia (AML) and 29 ALL (acute lymphoblastic leukemia) patients undergoing CBT were enrolled. For AML patients, the neutrophil engraftment was observed in 87.5% of reduced intensity conditioning (RIC) and 72.0% of myeloablative conditioning (MAC) (p = 0.242). The median RFS was 5 months and OS 7 months. Conditioning regimen did not affect relapse free survival (RFS) or overall survival (OS). GVHD prophylaxis using calcineurin inhibitors (CNI) plus methotrexate was associated with better RFS compared to CNI plus ATG (p = 0.032). For ALL patients, neutrophil engraftment was observed in 55.6% of RIC and 90.0% of MAC (p = 0.034). The median RFS was 5 months and OS 19 months. MAC regimens, especially total body irradiation (TBI)-based regimen, were associated with both longer RFS and OS compared to other conditioning regimens. In conclusion, individualized conditioning regimens will add value in terms of enhancing safety and efficacy of CBT.
Source: Journal of Clinical Medicine
DOI: 10.3390/jcm9072310
Institutions: Seoul National University, Seoul National University Hospital, CHA University, Jeonbuk National University Hospital, Jeonbuk National University, Keimyung University Dongsan Medical Center, Keimyung University, Ajou University, Samsung Medical Center, Sungkyunkwan University, Chonnam National University Hwasun Hospital, Soonchunhyang University, Soonchunhyang University Hospital Seoul, Konkuk University, Konkuk University Medical Center, Kyungpook National University Hospital, Kyungpook National University, Kyungpook National University Medical Center, Ewha Womans University, Ewha Womans University Medical Center, Ewha Womans University Seoul Hospital, Chungnam National University, Kyung Hee University, Gachon University, Asan Medical Center, University of Ulsan, Daegu Fatima Hospital, Gachon University Gil Medical Center
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,324
OpenAlex ID: W3044559132