scholarly journals Reduced-intensity unrelated cord blood transplantation for patients with advanced malignant lymphoma

2005 ◽  
Vol 11 (4) ◽  
pp. 314-318 ◽  
Author(s):  
Koichiro Yuji ◽  
Shigesaburo Miyakoshi ◽  
Daisuke Kato ◽  
Yuji Miura ◽  
Tomohiro Myojo ◽  
...  
Keyword(s):  
Cord Blood ◽  
Malignant Lymphoma ◽  
Cord Blood Transplantation ◽  
Unrelated Cord Blood Transplantation ◽  
Blood Transplantation ◽  
Unrelated Cord Blood ◽  
Reduced Intensity

Reduced-Intensity Versus Myeloablative Conditioning for Unrelated Cord Blood Transplantation in Adults with Acute Leukemia: A Report from Eurocord, the Acute Leukemia Working Party and the Cord Blood Committee of the Cellular Therapy & Immunobiology Working Party of the European Group for Blood and Marrow Transplantation

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 155-155
Author(s):  
Frederic Baron ◽  
Ruggeri Annalisa ◽  
Eric Beohou ◽  
Myriam Labopin ◽  
Guillermo Sanz ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Cord Blood ◽  
Research Funding ◽  
Cord Blood Transplantation ◽  
Working Party ◽  
Myeloablative Conditioning ◽  
Unrelated Cord Blood Transplantation ◽  
Blood Transplantation ◽  
Unrelated Cord Blood ◽  
Reduced Intensity

Abstract BACKRGOUND. Non-relapse mortality (NRM) is the first cause of treatment failure after unrelated cord blood transplantation (UCBT) following myeloablative conditioning (MAC). In the last decade, reduced-intensity conditionings (RIC) for UCBT have been developed with the aim of reducing NRM and allowing older patients and those with medical comorbidities to benefit from UCBT. The aim of our retrospective registry study was to compare outcomes of acute leukemia (AL) adult patients given UCBT after either RIC or MAC regimens. Regimens were classified as MAC or RIC based on EBMT criteria. PATIENTS AND METHODS. Data from 1352 adult (> 18 yrs) patients with AL (acute myeloid leukemia [AML; n=894] or acute lymphoblastic leukemia [ALL; n=458]) given a first single or double UCBT from 2004 to 2013 at EBMT-affiliated centers were included in this retrospective study. RESULTS. 518 patients were given UCB after RIC, while 834 patients were administered MAC. The most frequently used conditioning regimens combined either TBI, cyclophosphamide and Flu (TCF regimen, given in 22% of MAC vs 75% of RIC recipients, P<0.001), or thiotepa, Bu and Flu (TBF, given in 32% of MAC vs 6% of RIC recipients, P<0.001). In comparison to MAC recipients, RIC recipients were almost 2 decades older (median age 52.5 vs 33.7 yrs, P<0.001), were more often transplanted for AML (80% vs 57%, P=0.001), received more frequently 2 cord blood units (61 vs 32%, P<0.001), received more frequently units with > or = 2 HLA-mismatches (69% vs 58%, P<0.001), received more TNC (median 3.5x10E7 vs 2.9x10E7, P<0.001), and received less frequently ATG in the conditioning (23% versus 57%). Disease status at UCBT was comparable in both groups (51% of patients in CR1 and 17% >CR). Median follow-up for survivors was 25 months. In univariate analyses, in comparison to patients given MAC, RIC recipients had a similar rate of neutrophil engraftment (89.5 vs 89%, P=0.7), and a similar incidence of grade II-IV acute (34% vs 29%, P=0.1) and chronic (22% vs 26%, P= 0.22) GVHD. In contrast, at 2-yr, RIC recipients had a higher incidence of disease relapse (41 vs 24%, P<0.001) but a lower NRM (19 vs 37%, P<0.001), translating to similar leukemia-free survival (LFS, 40% vs 38%, P=0.6) but better overall survival (OS, 47 vs 42%, P=0.01) than MAC recipients (Figure 1). Further, among ALL patients, the use of TCF regimen (n=159) was associated lower NRM (21 vs 40% at 2-yr, P<0.001), lower relapse incidence (24 vs 34%, P=0.07), and better OS (63 vs 34%, P<0.001) and LFS (55 vs 27%, P<0.001). We performed separate multivariate analyses (MVA) for patients with AML and ALL. In MVA for AML patients, the use of RIC regimen was associated with a higher incidence of relapse (HR=1.6, P=0.005) but a suggestion for lower NRM (HR=0.7, P=0.1) translating to similar OS (HR=1.0, P=0.9) and LFS (HR=1.1, P=0.3). Similarly, in MVA for ALL patients, the use of RIC regimen was associated with a higher incidence of relapse (HR=2.0, P=0.002) but a lower NRM (HR=0.6, P=0.04) translating to similar OS (HR=0.8, P=0.2) and LFS (HR=1.1, P=0.5). Further, interestingly, conditioning with TCF-based regimen was associated with a lower incidence of relapse (HR=0.5, P=0.004) translating into better OS (HR=0.6, P=0.013) and LFS (HR 0.6, P=0.002) in ALL patients in MVA adjusted for conditioning intensity (RIC vs MAC). CONCLUSIONS. These data suggest that LFS and OS might be as good with RIC than with MAC in adults AL patients offered UCBT. These observations could serve as basis for future prospective randomized studies. Figure 1. Unadjusted UCBT outcomes in patients transplanted following RIC versus MAC. Figure 1. Unadjusted UCBT outcomes in patients transplanted following RIC versus MAC. Disclosures Milpied: Celgene: Honoraria, Research Funding. Sierra:Amgen: Research Funding; Novartis: Research Funding; Celgene: Research Funding. Mohty:Janssen: Honoraria; Celgene: Honoraria. Schmid:Neovii: Consultancy; Janssen Cilag: Other: Travel grand.

Unrelated Cord Blood Transplantation for Severe Acquired Aplastic Anemia Using a Reduced-Intensity Conditioning: High Graft Rejection but Good Survival

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2368-2368
Author(s):  
Huilan Liu ◽  
Liangquan Geng ◽  
Xingbing Wang ◽  
Kaiyang Ding ◽  
Baolin Tang ◽  
...  
Keyword(s):  
Cord Blood ◽  
Total Dose ◽  
Aplastic Anemia ◽  
Graft Rejection ◽  
Research Funding ◽  
Cord Blood Transplantation ◽  
Unrelated Cord Blood Transplantation ◽  
Blood Transplantation ◽  
Unrelated Cord Blood ◽  
Reduced Intensity

Abstract Abstract 2368 We report a single center experience in treating 16 consecutive patients (nine male and seven female) with severe aplastic anemia (AA) who received unrelated cord blood transplantation (UCBT) between 2006 and 2010. The main outcomes of interest were the tolerability and toxicity of UCBT, hematopoietic reconstitution and survival. The first two patients using a conditioning regimen consisting of cyclophosphamide (total dose 120°<<200 mg/kg), rabbit anti-thymocyte globulin (ATG, total dose 10°<<15 mg/kg) and methylprednisolone (total dose 1.5g). The other 14 cases received a reduced-intensity regimen composed of cyclophosphamide (total dose1200mg/©O), ATG (total dose 30 mg/kg) and fludarabine (total dose 120°<<180 mg/m2). Cyclosporine and mycophenolate mofetil were used as GVHD prophylaxis. The median age was 17 years (range 5–61 years) and the median weight was 48 kg (range 16–65 kg). Ten of sixteen were very SAA (VSAA). The median interval between diagnosis and UCBT was 30 days (range, 15–180). All except one did not received ATG-based immunosuppressive therapy before UCBT. Twelve patients received single UCB unit, four cases received double units. Donor/recipient HLA was at least four of six loci matching. The median nucleated cell dose infused was 4.27×107 cells/kg (range 2.34–13.41×107 cells/kg) and CD34+ cell dose infused was 2.02×105 cells/kg (range 0.71–4.35×105 cells/kg). Two patients were not evaluable for engraftment because of early death on day +21 and +22 due to severe infection and intracranial hemorrhages, respectively. Only one of the fourteen cases had engraftment with complete chimerism of single UCB unit from day 7, whose ANC© f 0.5 ×109/L and platelet© f20 ×109/L occurred on day 12 and day 31 post double UCBT, respectively. But she experienced secondary graft failure after three months post transplantation and attained survival by successful haplo-identical related transplantation. Thirteen patients experienced primary graft rejection, but all of them acquired autologous recovery. The 3-month and 6-month cumulative incidence of response was 61.5% and 85.7%, respectively. Currently, 14 patients are alive, having survived for 189 to 1712 days (median, 544 days) after their transplantations. The probability of overall survival at 4 years was 87.5%.Our data indicate that UCBT for new diagnosed SAA using no irradiation but fludarabine-based conditioning still seems to be inevitable to led to the high risk of rejection, but may facilitate autologous recovery and improve survival with low risk of transplant-related mortality. Disclosures: Sun: Fund of 11th Five-Year Science and Technology Key Project of Anhui Province (06013128B): Research Funding; Fund of Anhui Provincial “115” Industrial Innovation Program: Research Funding.

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