PMID- 33941226
OWN - NLM
STAT- MEDLINE
DCOM- 20210915
LR  - 20230920
IS  - 1756-8722 (Electronic)
IS  - 1756-8722 (Linking)
VI  - 14
IP  - 1
DP  - 2021 May 3
TI  - Allogeneic hematopoietic cell transplantation with cord blood versus mismatched 
      unrelated donor with post-transplant cyclophosphamide in acute myeloid leukemia.
PG  - 76
LID - 10.1186/s13045-021-01086-2 [doi]
LID - 76
AB  - BACKGROUND: Allogeneic hematopoietic cell transplantation (allo-HCT) using a 
      mismatched unrelated donor (MMUD) and cord blood transplantation (CBT) are valid 
      alternatives for patients without a fully human leukocyte antigen (HLA)-matched 
      donor. Here, we compared the allo-HCT outcomes of CBT versus 
      single-allele-mismatched MMUD allo-HCT with post-transplant cyclophosphamide 
      (PTCy) in acute myeloid leukemia. METHODS: Patients who underwent a first CBT 
      without PTCy (N = 902) or allo-HCT from a (HLA 9/10) MMUD with PTCy (N = 280) 
      were included in the study. A multivariate regression analysis was performed for 
      the whole population. A matched-pair analysis was carried out by propensity 
      score-based 1:1 matching of patients (177 pairs) with known cytogenetic risk. 
      RESULTS: The incidence of grade II-IV and grade III-IV acute graft-versus-host 
      disease (GVHD) at 6 months was 36% versus 32% (p = 0.07) and 15% versus 11% 
      (p = 0.16) for CBT and MMUD cohorts, respectively. CBT was associated with a 
      higher incidence of graft failure (11% vs. 4%, p < 0.01) and higher 2-year 
      non-relapse mortality (NRM) (30% vs. 16%, p < 0.01) compared to MMUD. In the 
      multivariate analysis, CBT was associated with a higher risk of, NRM (HR = 2.09, 
      95% CI 1.46-2.99, p < 0.0001), and relapse (HR = 1.35, 95% CI 1-1.83, p = 0.05), 
      which resulted in worse leukemia-free survival (LFS) (HR = 1.68, 95% CI 
      1.34-2.12, p < 0.0001), overall survival (OS) (HR = 1.7, 95% CI 1.33-2.17, 
      p < 0.0001), and GVHD-free, relapse-free survival (GRFS) (HR = 1.49, 95% CI 
      1.21-1.83, p < 0.0001) compared to MMUD. The risk of grade II-IV acute GVHD 
      (p = 0.052) and chronic GVHD (p = 0.69) did not differ significantly between the 
      cohorts. These results were confirmed in a matched-pair analysis. CONCLUSIONS: 
      CBT was associated with lower LFS, OS, and GRFS due to higher NRM, compared to 
      MMUD allo-HCT with PTCy. In the absence of a fully matched donor, 9/10 MMUD with 
      PTCy may be preferred over CBT.
FAU - Dholaria, Bhagirathbhai
AU  - Dholaria B
AUID- ORCID: 0000-0003-2371-3655
AD  - Department of Hematology-Oncology, Vanderbilt University Medical Center, 220 
      Pierce Ave, 777 Preston Research Building, Nashville, TN, 37232, USA. 
      Bhagirathbhai.R.Dholaria@vumc.org.
FAU - Labopin, Myriam
AU  - Labopin M
AD  - EBMT ALWP Office, Hopital Saint-Antoine, Paris, France.
FAU - Sanz, Jaime
AU  - Sanz J
AD  - Hematology Department, University Hospital La Fe, Valencia, Spain.
FAU - Ruggeri, Annalisa
AU  - Ruggeri A
AD  - Department of Pediatric Hematology and Oncology IRCCS, Ospedale Pediatrico 
      Bambino Gesu, Rome, Italy.
FAU - Cornelissen, Jan
AU  - Cornelissen J
AD  - Department of Hematology, Erasmus MC Cancer Institute, University Medical Center 
      Rotterdam, Rotterdam, The Netherlands.
FAU - Labussiere-Wallet, Helene
AU  - Labussiere-Wallet H
AD  - Hopital Lyon Sud, Hospices Civils de Lyon, Pierre Benite, France.
FAU - Blaise, Didier
AU  - Blaise D
AD  - Programme de Transplantation and Therapie Cellulaire, Centre de Recherche en 
      Cancerologie de Marseille, Institut Paoli Calmettes, Marseille, France.
FAU - Forcade, Edouard
AU  - Forcade E
AD  - Hopital Haut-Leveque, CHU Bordeaux, Pessac, France.
FAU - Chevallier, Patrice
AU  - Chevallier P
AD  - Department of D'Hematologie, CHU Nantes, Nantes, France.
FAU - Grassi, Anna
AU  - Grassi A
AD  - Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, 
      Italy.
FAU - Zubarovskaya, Ludmila
AU  - Zubarovskaya L
AD  - RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russian 
      Federation.
FAU - Kuball, Jurgen
AU  - Kuball J
AD  - Department of Haematology, University Medical Centre, Utrecht, The Netherlands.
FAU - Ceballos, Patrice
AU  - Ceballos P
AD  - Departement d'Hematologie Clinique, CHU Lapeyronie, Montpellier, France.
FAU - Ciceri, Fabio
AU  - Ciceri F
AD  - Ospedale San Raffaele S.R.L., Haematology and BMT, Milan, Italy.
FAU - Baron, Frederic
AU  - Baron F
AD  - CHU and University of Liege, Liege, Belgium.
FAU - Savani, Bipin N
AU  - Savani BN
AD  - Department of Hematology-Oncology, Vanderbilt University Medical Center, 220 
      Pierce Ave, 777 Preston Research Building, Nashville, TN, 37232, USA.
FAU - Nagler, Arnon
AU  - Nagler A
AD  - Chaim Sheba Medical Center, Tel Hashomer, Israel.
AD  - ALWP Office Hopital Saint-Antoine, Paris, France.
FAU - Mohty, Mohamad
AU  - Mohty M
AD  - EBMT ALWP Office, Hopital Saint-Antoine, Paris, France.
AD  - Service d'Hematologie Clinique et Therapie Cellulaire, Hopital Saint-Antoine, 
      UMRs 938, AP-HP, Sorbonne University, and INSERM, Paris, France.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20210503
PL  - England
TA  - J Hematol Oncol
JT  - Journal of hematology & oncology
JID - 101468937
RN  - 8N3DW7272P (Cyclophosphamide)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Cord Blood Stem Cell Transplantation/*methods
MH  - Cyclophosphamide/pharmacology/*therapeutic use
MH  - Female
MH  - Hematopoietic Stem Cell Transplantation/*methods
MH  - Humans
MH  - Leukemia, Myeloid, Acute/*drug therapy
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Transplantation Conditioning/*methods
MH  - Unrelated Donors
MH  - Young Adult
PMC - PMC8094558
OTO - NOTNLM
OT  - Acute leukemia
OT  - Acute myeloid leukemia
OT  - Allogeneic hematopoietic cell transplantation
OT  - Bone marrow
OT  - Cord blood transplantation
OT  - Cord blood unit
OT  - Disease relapse
OT  - Graft-versus-host disease
OT  - Human leukocyte antigen
OT  - Mismatched donor
OT  - Peripheral blood stem cell
OT  - Post-transplant cyclophosphamide
OT  - Toxicity
COIS- The authors report no relevant conflict of interest in relation to this work.
EDAT- 2021/05/05 06:00
MHDA- 2021/09/16 06:00
PMCR- 2021/05/03
CRDT- 2021/05/04 05:54
PHST- 2021/02/24 00:00 [received]
PHST- 2021/04/27 00:00 [accepted]
PHST- 2021/05/04 05:54 [entrez]
PHST- 2021/05/05 06:00 [pubmed]
PHST- 2021/09/16 06:00 [medline]
PHST- 2021/05/03 00:00 [pmc-release]
AID - 10.1186/s13045-021-01086-2 [pii]
AID - 1086 [pii]
AID - 10.1186/s13045-021-01086-2 [doi]
PST - epublish
SO  - J Hematol Oncol. 2021 May 3;14(1):76. doi: 10.1186/s13045-021-01086-2.