Higher survival following transplantation with a mismatched unrelated donor with posttransplant cyclophosphamide‐based graft‐versus‐host disease prophylaxis than with double unit umbilical cord blood in patients with acute myeloid leukemia in first complete remission: A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation
Year: 2024
Type: article
Study design: Observational Study
Abstract: The best donor option for acute myeloid leukemia (AML) patients lacking an HLA-matched donor has remained intensively debated. We herein report the results of a large retrospective registry study comparing hematopoietic cell transplantation (HCT) outcomes between double-unit umbilical cord blood transplantation (dCBT, n = 209) versus 9/10 HLA-matched unrelated donor (UD) with posttransplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis (UD 9/10, n = 270) in patients with AML in first complete remission (CR1). Inclusion criteria consisted of adult patient, AML in CR1 at transplantation, either peripheral blood stem cells (PBSC) from UD 9/10 with PTCy as GVHD prophylaxis or dCBT without PTCy, transplantation between 2013 and 2021, and no in vivo T-cell depletion. The 180-day cumulative incidence of grade II-IV acute GVHD was 29% in UD 9/10 versus 44% in dCBT recipients (p = .001). After adjustment for covariates, dCBT recipients had a higher non-relapse mortality (HR = 2.35, 95% CI: 1.23-4.48; p = .01), comparable relapse incidence (HR = 1.12, 95% CI: 0.67-1.86; p = .66), lower leukemia-free survival (HR = 1.5, 95% CI: 1.01-2.23; p = .047), and lower overall survival (HR = 1.66, 95% CI: 1.08-2.55; p = .02) compared with patients receiving UD 9/10 HCT. In summary, our results suggest that transplantation outcomes are better with UD 9/10 with PTCy-based GVHD prophylaxis than with dCBT for AML patients in CR1. These data might support the use of UD 9/10 with PTCy-based GVHD prophylaxis over dCBT in AML patients lacking an HLA-matched donor.
Source: American Journal of Hematology
DOI: 10.1002/ajh.27466
Authors: Frédéric Baron, Myriam Labopin, Jurjen Versluis, Jan Vydra, Peter A. von dem Borne, Emma Nicholson, Didier Blaise, Rachel Protheroe, Alexander Kulagin, Claude Eric Bulabois, Montserrat Rovira, Patrice Chevallier, Edouard Forcade, Jenny Byrne, Jaime Sanz, Annalisa Ruggeri, Mohamad Mohty, Fabio Ciceri
Institutions: University of Liège, Centre Hospitalier Universitaire de Liège, Inserm, Sorbonne Université, Hôpital Saint-Antoine, European Society for Blood and Marrow Transplantation, Erasmus MC, Erasmus MC Cancer Institute, Institute of Haematology and Blood Transfusion, Leiden University Medical Center, Royal Marsden Hospital, Aix-Marseille Université, Institut Paoli-Calmettes, Laboratoire Management Sport Cancer, University Hospitals Bristol and Weston NHS Foundation Trust, First Pavlov State Medical University of St. Petersburg, Université Grenoble Alpes, Hospital Clínic de Barcelona, Centre Hospitalier Universitaire de Nantes, Nantes Université, Centre Hospitalier Universitaire de Bordeaux, University of Nottingham, Hospital Universitari i Politècnic La Fe, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4402093407