Comparison of outcomes after unrelated cord blood and unmanipulated haploidentical stem cell transplantation in adults with acute leukemia
Por:
Ruggeri, A, Labopin, M, Sanz, G, Piemontese, S, Arcese, W, Bacigalupo, A, Blaise, D, Bosi, A, Huang, H, Karakasis, D, Koc, Y, Michallet, M, Picardi, A, Sanz, J, Santarone, S, Sengelov, H, Sierra, J, Vincent, L, Volt, F, Nagler, A, Gluckman, E, Ciceri, F, Rocha, V, Mohty, M
Publicada:
1 sep 2015
Resumen:
Outcomes after unmanipulated haploidentical stem cell transplantation (Haplo) and after unrelated cord blood transplantation (UCBT) are encouraging and have become alternative options to treat patients with high-risk acute leukemia without human leukocyte antigen (HLA) matched donor. We compared outcomes after UCBT and Haplo in adults with de novo acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Median follow-up was 24 months. Analysis was performed separately for patients with AML, n = 918 (Haplo = 360, UCBT = 558) and ALL, n = 528 (Haplo = 158 and UCBT = 370). UCBT was associated with delayed engraftment and higher graft failure in both AML and ALL recipients. In multivariate analysis, UCBT was associated with lower incidence of chronic graft-vs-host disease both in the AML group (hazard ratio (HR) = 0.63, P = 0.008) and in the ALL group (HR = 0.58, P = 0.01). Not statistically significant differences were observed between Haplo and UCBT for relapse incidence (HR = 0.95, P = 0.76 for AML and HR = 0.82, P = 0.31 for ALL), non-relapse mortality (HR = 1.16, P = 0.47 for AML and HR = 1.23, P = 0.23 for ALL) and leukemia-free survival (HR 0.78, P = 0.78 for AML and HR = 1.00, P = 0.84 for ALL). There were no statistically differences on main outcomes after unmanipulated Haplo and UCBT, and both approaches are valid for acute leukemia patients lacking a HLA matched donor. Both strategies expand the donor pool for patients in need.
Filiaciones:
Ruggeri, A:
Hop St Antoine, AP HP, Serv Hematol & Therapie Cellulaire, F-75012 Paris, France
INSERM, UMRs 938, Paris, France
IUH Univ Paris VII, Hop St Louis, Paris, France
Labopin, M:
Hop St Antoine, AP HP, Serv Hematol & Therapie Cellulaire, F-75012 Paris, France
Univ Paris 06, Hop St Antoine, Paris, France
Sanz, G:
Hosp Univ & Politecn La Fe, Valencia, Spain
Piemontese, S:
Ist Sci San Raffaele, Hematol & BMT Unit, I-20132 Milan, Italy
Arcese, W:
Univ Roma Tor Vergata, Rome Transplant Network, Rome, Italy
Bacigalupo, A:
Osped San Martino Genova, Dipartimento Ematol, Genoa, Italy
Blaise, D:
Inst J Paoli I Calmettes, F-13009 Marseille, France
Bosi, A:
Careggi Univ Hosp, Florence, Italy
Huang, H:
Zhejiang Univ, Sch Med, Affiliated Hosp 1, Bone Marrow Transplantat Ctr, Hangzhou 310003, Zhejiang, Peoples R China
Karakasis, D:
Evangelismos Med Ctr, Div Hematol, BMT Unit, Athens, Greece
Koc, Y:
Med Pk, Stem Cell Transplant Unit, Antalya, Turkey
Michallet, M:
Hop Edouard Herriot, Lyon, France
Picardi, A:
Univ Roma Tor Vergata, Rome Transplant Network, Rome, Italy
Sanz, J:
Hosp Univ & Politecn La Fe, Valencia, Spain
Santarone, S:
Osped Civile, Dipartimento Ematol, BMT Unit, Pescara, Italy
Sengelov, H:
Rigshosp, DK-2100 Copenhagen, Denmark
Sierra, J:
Univ Autonoma Barcelona, Jose Carreras Inst, Hosp Santa Creu & St Pau, E-08193 Barcelona, Spain
Vincent, L:
CHU Montpellier, Montpellier, France
Volt, F:
IUH Univ Paris VII, Hop St Louis, Paris, France
Nagler, A:
Chaim Sheba Med Ctr, IL-52621 Tel Hashomer, Israel
ALWP Off Hop St Antoine, AP HP, Serv Hematol & Therapie Cellulaire, Paris, France
Gluckman, E:
IUH Univ Paris VII, Hop St Louis, Paris, France
Ctr Sci Monaco, Monacord, Monaco, Monaco
Ciceri, F:
Ist Sci San Raffaele, Hematol & BMT Unit, I-20132 Milan, Italy
Rocha, V:
IUH Univ Paris VII, Hop St Louis, Paris, France
Univ Oxford, Churchill Hosp, Oxford, England
Mohty, M:
Hop St Antoine, AP HP, Serv Hematol & Therapie Cellulaire, F-75012 Paris, France
INSERM, UMRs 938, Paris, France
Univ Paris 06, Hop St Antoine, Paris, France
Bronze
|