Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
8429975 | Biology of Blood and Marrow Transplantation | 2018 | 28 Pages |
Abstract
Haplo/cord transplantation combines an umbilical cord blood (UCB) graft with CD34-selected haploidentical cells and results in rapid hematopoietic recovery followed by durable UCB engraftment. We compared outcomes of transplants in older patients with acute myeloid leukemia (AML) or high-risk myelodysplastic syndromes (MDS) who received either HLA-matched unrelated donor (MUD) cells or haplo/cord grafts. Between 2007 and 2013, 109 adults ages 50 and older underwent similar reduced-intensity conditioning with fludarabine and melphalan and antibody-mediated T cell depletion for AML (nâ=â83) or high-risk MDS (nâ=â26) followed by either a MUD (nâ=â68) or haplo/cord (nâ=â41) graft. Patient characteristics were similar for each graft source except for more minority patients receiving a haplo/cord transplant (Pâ=â.01). One half of the AML patients were not in remission. Two-year progression-free survival (PFS), overall survival (OS), and graft-versus-host disease-free relapse-free survival were 38%, 48%, and 32.1% for MUD and 33%, 48%, and 33.8% for haplo/cord transplants (Pâ=â.62 for PFS; Pâ=â.97 for OS; Pâ=â.84), respectively. Acute grades II to IV and chronic graft-versus-host-disease rates did not differ at 19.5% and 4.9% in haplo/cord compared with 25% and 7.4% after MUD (Pâ=â.53 and Pâ=â.62, respectively). Multivariate analysis confirmed no significant differences in transplant outcomes by donor type. Haplo/cord reduced-intensity transplantation achieves similar outcomes relative to MUD in older AML and MDS patients, making this a promising option for those without matched donors.
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Authors
Stephanie B. Tsai, Joanna Rhodes, Hongtao Liu, Tsiporah Shore, Michael Bishop, Melissa M. Cushing, Usama Gergis, Lucy Godley, Justin Kline, Richard A. Larson, Sebastian Mayer, Olatoyosi Odenike, Wendy Stock, Amittha Wickrema, Koen van Besien,