Reduced-Intensity versus Myeloablative Conditioning in Cord Blood Transplantation for Acute Myeloid Leukemia (40-60 years) across Highly Mismatched HLA Barriers-On Behalf of Eurocord and the Cellular Therapy & Immunobiology Working Party (CTIWP) of EBMT
Por:
Sheth, V, Volt, F, Sanz, J, Clement, L, Cornelissen, J, Blaise, D, Sierra, J, Michallet, M, Saccardi, R, Rocha, V, Gluckman, E, Chabannon, C, Ruggeri, A
Publicada:
1 nov 2020
Resumen:
The use of myeloablative conditioning (MAC) in umbilical cord blood transplantation (UCBT) has been associated with high nonrelapse mortality (NRM) in patients aged >40 years, especially those having a high HLA disparity, thus limiting wider applications. We hypothesized that the NRM advantage of reduced-intensity conditioning (MC) and higher graft-versus-leukemia effect associated with greater HLA disparities would expand its use for patients (aged 40 to 60 years) without compromising efficacy and compared outcomes between RIC and MAC regimens. In total, 288 patients aged 40 to 60 years, with de novo acute myeloid leukemia, receiving UCBT with at least 2 HLA mismatches with MC (n = 166) or MAC (n = 122) regimens were included. As compared to MC, the MAC cohort included relatively younger patients, having received more single UCBT, with lower total nucleated cell counts and more in vivo T cell depletion. Median time to neutrophil engraftment, infections (bacterial, viral, and fungal), and grade II to IV acute and chronic graft-versus-host disease were similar in both groups. In the multivariate analysis, overall survival (hazard ratio [HR], 0.98; P = .9), NRM (HR, 0.68; P = .2), and relapse (HR, 1.24; P = .5) were not different between MC and MAC. Refractory disease was associated with worse survival. Outcomes of UBCT for patients aged 40 to 60 years having >2 HLA mismatches are comparable after the MC or MAC regimen. (C) 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
Filiaciones:
Sheth, V:
Fred Hutchison Canc Res Ctr, Div Clin Res, Program Immunol, Seattle, WA USA
Volt, F:
Hop St Louis, Eurocord, EA3518, Paris, France
Sanz, J:
Hosp Univ La Fe, Dept Stem Cell Transplant & Immunotherapy, Valencia, Spain
Clement, L:
Dept Stem Cell Transplant & Immunotherapy, Bordeaux, France
Cornelissen, J:
Erasmus MC Daniel den Hoed Canc Ctr, Dept Stem Cell Transplant & Immunotherapy, Rotterdam, Netherlands
Blaise, D:
Paoli Calmettes, Dept Stem Cell Transplant & Immunotherapy, Marseille, France
Sierra, J:
Hosp Santa Creu & Sant Pau, Dept Stem Cell Transplant & Immunotherapy, Barcelona, Spain
Michallet, M:
Ctr Leon Berard, Dept Stem Cell Transplant & Immunotherapy, Serv Hematol, Lyon, France
Saccardi, R:
Azienda Osped Univ Meyer, Dept Stem Cell Transplant & Immunotherapy, Osped Careggi, Florence, Italy
Rocha, V:
Hop St Louis, Eurocord, EA3518, Paris, France
Gluckman, E:
Hop St Louis, Eurocord, EA3518, Paris, France
Chabannon, C:
Aix Marseille Univ, Ctr Therapie Cellulaire, Inst Paoli Calmettes, Dept Biol Canc, Marseille, France
Aix Marseille Univ, Inserm CBT 1409, Marseille, France
Ruggeri, A:
Hop St Louis, Eurocord, EA3518, Paris, France
IRCCS San Raffaele Sci Inst, Haematol & Bone Marrow Transplant Unit, Milan, Italy
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