scholarly journals Better outcomes of modified myeloablative conditioning without antithymocyte globulin versus myeloablative conditioning in cord blood transplantation for hematological malignancies: A retrospective (development) and a prospective (validation) study

2018 ◽  
Vol 143 (3) ◽  
pp. 699-708 ◽  
Author(s):  
Zimin Sun ◽  
Huilan Liu ◽  
Chenhui Luo ◽  
Liangquan Geng ◽  
Changcheng Zheng ◽  
...  
Keyword(s):  
Cord Blood ◽  
Validation Study ◽  
Antithymocyte Globulin ◽  
Hematological Malignancies ◽  
Cord Blood Transplantation ◽  
Myeloablative Conditioning ◽  
Blood Transplantation

Intensified Myeloablative Conditioning Regimen without Antithymocytic (ATG) Results in Superior Patient Outcome Compared to Myeloablative Conditioning Regimen for Single-Unit Umbilical Cord Blood Transplantation in Hematological Malignancies

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5837-5837
Author(s):  
Zimin Sun ◽  
Huilan Liu ◽  
Yue Wu ◽  
Changcheng Zheng ◽  
Baolin Tang ◽  
...  
Keyword(s):  
Cord Blood ◽  
Cumulative Incidence ◽  
Single Unit ◽  
Hematological Malignancies ◽  
Cord Blood Transplantation ◽  
Conditioning Regimen ◽  
Myeloablative Conditioning ◽  
Blood Transplantation ◽  
Group A ◽  
Neutrophil Engraftment

Abstract The superiority and safety of strengthening conditioning regimen for single- unit unrelated cord blood transplantation (sUCBT) in hematological malignancies remain controversial. We retrospectively analyzed the clinical data of 251 hematological malignancies undergoing sUCBT from Apr 2000 to Dec 2014 at Department of hematology in Anhui Provincial Hospital. Out of the 251 patients, 216 received the intensified myeloablative conditioning regimen (IMCR), and 35 received the myeloablative conditioning regimen (MCR). We evaluated the effect of IMCR without using Antithymocyte globulin (ATG) on patient outcomes. The cumulative incidence of myeloid and platelet engraftment of the IMCR group was significantly higher than that in the MCR group (96.98% vs. 82.81%, 85.89% vs. 51.79%, P=0.000 and 0.003, respectively). Corresponding incidences of transplantation-related mortality (TRM) by 180 days in the IMCR group and the MCR group were 19.50% vs. 41.67% (P=0.003), respectively. There were no differences in the incidence of grade II to IV acute GVHD (aGVDH), grade III to IV aGVHD and 2-year cumulative incidence of relapse. Up to Dec. 2015, with a median follow-up of 30 months, the estimated 3-year overall survival and disease- free survival in the IMCR group were both significantly higher than that of the MCR group (64.8% vs. 35.5%, 61.6% vs. 35.5%, P=0.000 and 0.001, respectively). This study is the first to show the superiority of intensified myeloablative regimen to conventional myeloablative regimen.A large-scale prospective study was needed. (A) (B) Figure 1 The cumulative incidence of neutrophil and platelet engraftment of the IMCR group and MCR group. (A)The cumulative incidence of neutrophil engraftment of the IMCR group was predominantly higher than that in the MCR group(96.98% vs. 82.81%, P=0.000). (B)The cumulative incidence of platelet engraftment of the IMCR group was also higher than that in the MCR group(85.89% vs. 51.79%, P=0.003). Figure 1. The cumulative incidence of neutrophil and platelet engraftment of the IMCR group and MCR group. (A)The cumulative incidence of neutrophil engraftment of the IMCR group was predominantly higher than that in the MCR group(96.98% vs. 82.81%, P=0.000). (B)The cumulative incidence of platelet engraftment of the IMCR group was also higher than that in the MCR group(85.89% vs. 51.79%, P=0.003). Figure 2 Comparison of the incidence of 3-year OS between the IMCR group and the MCR group.The incidence of 3-year OS of the IMCR group is predominantly higher than that of the MCR group(62.4% vs. 35.5%,P=0.001). Figure 2. Comparison of the incidence of 3-year OS between the IMCR group and the MCR group.The incidence of 3-year OS of the IMCR group is predominantly higher than that of the MCR group(62.4% vs. 35.5%,P=0.001). Figure 3 Figure 3. Disclosures No relevant conflicts of interest to declare.

Comparison of Outcomes after Double or Single-Unit Cord Blood Transplantation in Patients with Hematological Malignancies Using TBI-Containing Myeloablative Conditioning Regimen, a Retrospective Matched Control Study on Behalf of C-SHOT0507 and JSHCT Registry Data in Japan

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2548-2548
Author(s):  
Atsushi Wake ◽  
Shunro Kai ◽  
Masaya Okada ◽  
Koji Kato ◽  
Naoyuki Uchida ◽  
...  
Keyword(s):  
Cord Blood ◽  
Phase Ii ◽  
Single Unit ◽  
Hematological Malignancies ◽  
Matched Control ◽  
Disease Risk ◽  
Cord Blood Transplantation ◽  
Myeloablative Conditioning ◽  
Blood Transplantation ◽  
Gvhd Prophylaxis

Abstract INTRODUCITON: We reported the outcomes of double-unit cord blood transplantation (dCBT) after myeloablative conditioning performed in a prospective multicenter phase II study (C-SHOT0507) (Biol Blood Marrow Transplant 19, 2013: 812-819). However, the benefit of using double unit compared to single unit was not clearly shown. We performed matched control analysis to compare dCBT and single-unit CBT (sCBT), using C-SHOT0507 data of dCBT and registry data of sCBT. METHODS: Between Apr.2006 and Jan.2010, 61 cases of dCBT in C-SHOT0507 phase II clinical study and 932 cases of sCBT were performed in Japan. Because all cases of dCBT perfomed by TBI12Gy containing myeloablative conditioning (CA/Cy/TBI +/- G-CSF for myeloid and Cy/TBI for lymphoid) and uniform GVHD prophylaxis (CSA/MTX), we excluded reduced intensity conditioning and myeloablative conditioning without TBI 12 Gy from the cases of sCBT. Finally 307 sCBT patients who had hematological malignancies (AML170, ALL80, MDS24, CML14 and ML20) were extracted. All the sCBT recipients received uniform preconditioning described above and same GVHD prophylaxis (CSA/MTX), selected as a matched control cohort of dCBT C-SHOT0507 study. All statistical analyses were performed using EZR (Kanda Y, Saitama Medical Center, Jichi Medical University), a graphical user interface for R (The R Foundation for Statistical Computing, version 2.13.0). RESULTS: Median observation period of survivors was 1431 (106-2315) days post-transplant. Backgrounds of dCBT group and matched-control sCBT group were comparable except gender: (dCBT:M/F = 53 /8 versus sCBT:M/F = 154/153). Median age were 37 (10-54) in dCBT and 40 (14-54) in sCBT. Disease risk included standard 27, advanced 34 cases in dCBT, and standard 142, advanced 165 cases in sCBT. sCBT were grouped according to infused TNC number; 148 cases of low TNC (<2.5x107/kg) group (lowTNC) including 35 cases of <2.0x107/kg, and 159 cases of high TNC (>=2.5x107/kg) group (highTNC). Cumulative incidence (C.I.) of neutrophil engraftment were 87.2% (69.5-95.0) in dCBT, 84.7% (76.2-90.3) in sCBT of low TNC and 86.8% (79.3-91.7) in those of high TNC (n.s.) [Figure] and median days of engraftment were 25, 23, 22 days, respectively. 3yEFS were 44.3% (31.8-56.7), 41.6% (33.5-49.7), 44.0% (36.1-51.9) [Figure], and 3yOS were 52.3% (39.7-64.8), 48.7% (40.5-56.9), 51.0%(43.1-59.0), respectively. There were no statistically significant differences in both of them. C.I. of NRM were 24.1% (13.9-35.7), 31.0% (22.0-40.3), 40.0% (18.0-61.3), acute GVHDII-IV were 30.8% (18.2-44.4), 41.9% (33.1-50.4), 54.8% (45.5-63.1), acute GVHDIII-IV were 10.8% (3.2-23.6), 12.7% (6.8-20.6), 19.0% (11.4-28.1), chronic GVHD were 31.6% (19.8-44.1), 41.4% (32.6-50.0), 33.8% (26.2-41.6), and relapse incidences were 24.6% (14.6-36.1), 24.5% (17.7-31.8), 26.3% (19.6-33.5), respectively. All parameters assessed showed no significant differences between dCBT, sCBT, sCBT of low TNC and high TNC, except C.I of acute GVHDII-IV and NRM. In multivariate analysis, disease risk was an only significant factor affected on EFS (HR0.58; 95%CI: 0.400-0.833, P=0.003). DISCUSSION: Although this is a retrospective analysis, double-unit use for CBT showed no statistically significant impact on engraftment rate and transplant outcomes compared to single-unit use of CBT even in patients of TNC number lower than 2.5x107/kg after myeloablative conditioning in Japan. Since more than 90% of the transplant candidates can find single CB unit >2x107/kg TNC, advantage of adding another CB unit may be quite limited in Japan both scientifically and financially, until meaningful benefit is demonstrated by randomized phase III study such as BMT-CTN 0501. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

Outcomes of Adolescents and Young Adults Compared with Children with Acute Leukemia after Single-Unit Unrelated Cord Blood Transplantation Using Myeloablative Conditioning without Antithymocyte Globulin

2021 ◽  
pp. 1-11
Author(s):  
Xuhan Zhang ◽  
Huilan Liu ◽  
Changcheng Zheng ◽  
Baolin Tang ◽  
Xiaoyu Zhu ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Single Unit ◽  
Antithymocyte Globulin ◽  
Immune Reconstitution ◽  
Cord Blood Transplantation ◽  
Myeloablative Conditioning ◽  
Platelet Recovery ◽  
Blood Transplantation ◽  
Cell Counts ◽  
Neutrophil Engraftment

<b><i>Background:</i></b> Although the use of cord blood transplantation (CBT) is becoming more frequent in acute leukemia, considering the relationship between the low stem cell dose and graft failure, whether use of CBT for adolescents and young adults (AYAs) is appropriate remains uncertain. <b><i>Methods:</i></b> A retrospective registry-based analysis of clinical outcomes and immune reconstitution was conducted for 105 AYAs and 187 children with acute leukemia who underwent single-unit CBT using myeloablative conditioning (MAC) without antithymocyte globulin (ATG). <b><i>Results:</i></b> Outcomes were similar between AYAs and children, except for nonrelapse mortality (NRM) and recovery rates of neutrophils and platelets. The 30-day cumulative incidence of neutrophil engraftment was similar between AYAs and children, but children had faster rates of neutrophil and platelet recovery than AYAs. The median time to neutrophil engraftment was earlier in children than in AYAs (AYAs, 19 days, 95% confidence interval [CI] 17.3–21.7; children, 16 days, 95% CI 13.1–19.5, <i>p =</i> 0.00003). The incidence of platelet recovery on day 120 was higher in children than in AYAs (AYAs, 80%, 95% CI 71–81%; children, 88%, 95% CI 82–92%, <i>p =</i> 0.037). CD34<sup>+</sup> cell dose was the only independent factor influencing both neutrophil and platelet recovery. The cumulative incidence of NRM at 2 years was higher among AYAs than among children (AYAs, 27.5%, 95% CI 20–37%; children, 15%, 95% CI 10–21%, <i>p =</i> 0.008). Conditioning regimen was an independent factor influencing NRM. With respect to immune reconstitution, natural killer cell counts quickly recovered to normal levels 1-month post-CBT in both children and AYAs. CD8<sup>+</sup> T-cell counts were higher in children than in AYAs at 1 and 3 months post-CBT. CD4<sup>+</sup> T-cell counts were similar in both children and AYAs after CBT. <b><i>Conclusion:</i></b> AYAs with acute leukemia have outcomes of single-unit CBT using MAC without ATG that are as good as those of children. Thus, single-unit CBT using modified MAC without ATG is an acceptable choice for both AYAs and children who do not have a suitable donor.

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