Single Cord Blood Transplantation Versus Unmanipulated Haploidentical Transplantation for Adults with Acute Myeloid Leukemia in Complete Remission

Takaaki Konuma, Junya Kanda, Satoshi Yamasaki, Kaito Harada, Yoshimitsu Shimomura, Seitaro Terakura, Shohei Mizuno, Naoyuki Uchida, Masatsugu Tanaka, Noriko Doki, Yukiyasu Ozawa, Hirohisa Nakamae, Masashi Sawa, Ken ichi Matsuoka, Satoshi Morishige, Yumiko Maruyama, Kazuhiro Ikegame, Takafumi Kimura, Yoshinobu Kanda, Tatsuo IchinoheYoshiko Atsuta, Masamitsu Yanada

研究成果: Contribution to journalArticle査読

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抄録

Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative post-remission therapy for adult patients with acute myeloid leukemia (AML) in complete remission (CR). The availability of alternative human leukocyte antigen (HLA)-mismatched donors, such as cord blood and haploidentical related donors, could allow patients to receive allogeneic HCT who are without an HLA-matched sibling or unrelated donor. The use of these alternative donors is preferable for patients with advanced disease due to the rapid availability. However, comparative data for cord blood transplantation (CBT) and haploidentical related donor transplantation (haplo-HCT) are limited for adult patients with AML in CR. We sought to compare overall survival (OS); leukemia-free survival (LFS); graft-versus-host disease (GVHD)-free, relapse-free survival (GRFS); and chronic GVHD-free, relapse-free survival (CRFS) between single-unit CBT (SCBT) and haplo-HCT recipients for adult patients with intermediate- or poor-risk AML in CR. We retrospectively analyzed and compared the results of allogeneic hematopoietic cell transplantation in 1313 adult patients with intermediate- or poor-risk AML in CR who received either SCBT (n = 1102) or unmanipulated haplo-HCT (n = 211) between 2007 and 2018 in Japan. Among the whole cohort, the cumulative incidences of neutrophil and platelet recovery were significantly lower in SCBT recipients compared with those in haplo-HCT recipients (P < .001 for neutrophil, P < .001 for platelet). SCBT was significantly associated with a higher incidence of grade II to IV acute GVHD and lower incidence of extensive chronic GVHD compared to haplo-HCT (P = .013 for grades II to IV acute GVHD; P = .006 for extensive chronic GVHD). Haplo-HCT recipients developed a higher incidence of cytomegalovirus (CMV) antigenemia compared to SCBT recipients (P = .004). In the multivariate analysis, there were no significant differences for grades III or IV acute GVHD (hazard ratio [HR], 1.17; 95% confidence interval [CI],. 88 to 1.57; P = .26), relapse incidence (HR, 1.09; 95% CI,. 76 to 1.58; P = .61), non-relapse mortality (HR,. 83; 95% CI,. 58 to 1.18; P = .32), OS (HR,. 92; 95% CI,. 70 to 1.20; P = .56), LFS (HR,. 94; 95% CI,. 73 to 1.21; P = .67), GRFS (HR, 1.12; 95% CI,. 90 to 1.40; P = .27), or CRFS (HR, 1.15; 95% CI,. 92 to 1.44; P = .19) between the two donor types. In the propensity score matching analysis, which identified 180 patients in each cohort, there were no significant differences in transplant outcomes between the two donor types, except for delayed neutrophil (P < .001) and platelet recovery (P < .001) and a higher incidence of grades II to IV acute GVHD (P = .052) in SCBT. SCBT and unmanipulated haplo-HCT had similar survival outcomes for adult patients with AML in CR despite the lower hematopoietic recovery and higher grade II to IV acute GVHD in SCBT recipients and the higher CMV antigenemia in haplo-HCT recipients.

本文言語英語
ページ(範囲)334.e1-334.e11
ジャーナルTransplantation and Cellular Therapy
27
4
DOI
出版ステータス出版済み - 4 2021
外部発表はい

All Science Journal Classification (ASJC) codes

  • 血液学
  • 移植
  • 免疫アレルギー学
  • 細胞生物学
  • 分子医療
  • 医学(全般)

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