Faculty Collaboration Database

Outcomes of UCB transplantation are comparable in FLT3+ AML: results of CIBMTR, EUROCORD and EBMT collaborative analysis. Leukemia 2017 Jun;31(6):1408-1414

Date

01/26/2017

Pubmed ID

28119528

Pubmed Central ID

PMC5462854

DOI

10.1038/leu.2017.42

Scopus ID

2-s2.0-85012303056 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

Allogeneic hematopoietic cell transplantation (HCT) from siblings or unrelated donors (URD) during complete remission (CR) may improve leukemia-free survival (LFS) in FMS-like tyrosine kinase 3+ (FLT3+) acute myeloid leukemia (AML), which has poor prognosis because of high relapse rates. Umbilical cord blood (UCB) HCT outcomes are largely unknown in this population. We found that compared with sibling HCT, relapse risks were similar after UCB (n=126) (hazard ratio (HR) 0.86, P=0.54) and URD (n=91) (HR 0.81, P=0.43). UCB HCT was associated with statistically higher non-relapse mortality compared with sibling HCT (HR 2.32, P=0.02), but not vs URD (HR 1.72, P=0.07). All three cohorts had statistically nonsignificant 3-year LFS: 39% (95% confidence interval (CI): 30-47) after UCB, 43% (95% CI: 30-54) after sibling and 50% (95% CI: 40-60) after URD. Chronic graft-versus-host disease rates were significantly lower after UCB compared with either sibling (HR 0.59, P=0.03) or URD (HR 0.49, P=0.001). Adverse factors for LFS included high leukocyte count at diagnosis and HCT during CR2 (second CR). UCB is a suitable option for adults with FLT3+ AML in the absence of an human leukocyte antigen-matched sibling and its immediate availability may be particularly important for FLT3+ AML where early relapse is common, thus allowing HCT in CR1 (first CR) when outcomes are best.

Author List

Ustun C, Giannotti F, Zhang MJ, Wang HL, Brunstein C, Labopin M, Rocha V, de Lima M, Baron F, Sandmaier BM, Eapen M, Gluckman E, Nagler A, Weisdorf DJ, Ruggeri A

Authors

Mary Eapen MBBS, DCh, MRCPI, MS Professor in the Medicine department at Medical College of Wisconsin
Mei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Cord Blood Stem Cell Transplantation
Female
Follow-Up Studies
Graft vs Host Disease
Humans
Leukemia, Myeloid, Acute
Male
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Prognosis
Remission Induction
Retrospective Studies
Survival Rate
Transplantation Conditioning
Unrelated Donors
Young Adult