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A decision analysis comparing unrelated bone marrow transplantation and cord blood transplantation in patients with aggressive adult T-cell leukemia-lymphoma.

Abstract
Patients with aggressive adult T-cell leukemia-lymphoma (ATL) have dismal outcomes with intensive chemotherapy. Early up-front allogeneic hematopoietic stem cell transplantation (allo-HSCT) is generally recommended. However, the choice of stem cell source, i.e., unrelated bone marrow transplant (UBMT) or cord blood transplantation (CBT), when an HLA-matched related donor is unavailable remains controversial. Thus, we undertook a decision analysis to compare the outcomes of two therapeutic strategies: chemotherapy followed by up-front UBMT at 6 months, and chemotherapy followed by up-front CBT at 3 months. Patients were stratified into low-, intermediate-, and high-risk groups according to the modified ATL-prognostic index. The model simulated life expectancy (LE) and quality-adjusted LE (QALE). LE following up-front UBMT was higher than that following up-front CBT in the low-risk group (2.63 vs. 2.28 years), but was comparable in the intermediate- (2.06 vs. 2.01 years) and high-risk groups (1.25 vs. 1.30 years). The Monte Carlo simulation for LE and QALE in each risk group showed that there was significant uncertainty in all categories. In conclusion, up-front UBMT was superior to up-front CBT in the low-risk group, but the strategies were comparable in the intermediate- and high-risk groups.
AuthorsShigeo Fuji, Saiko Kurosawa, Yoshihiro Inamoto, Tatsunori Murata, Atae Utsunomiya, Kaoru Uchimaru, Satoshi Yamasaki, Yoshitaka Inoue, Yukiyoshi Moriuchi, Ilseung Choi, Masao Ogata, Michihiro Hidaka, Takuhiro Yamaguchi, Takahiro Fukuda
JournalInternational journal of hematology (Int J Hematol) Vol. 111 Issue 3 Pg. 427-433 (Mar 2020) ISSN: 1865-3774 [Electronic] Japan
PMID31701480 (Publication Type: Comparative Study, Journal Article)
Topics
  • Adult
  • Aged
  • Allografts
  • Bone Marrow Transplantation
  • Decision Support Techniques
  • Disease Progression
  • Female
  • Fetal Blood (transplantation)
  • Humans
  • Leukemia-Lymphoma, Adult T-Cell (therapy)
  • Male
  • Middle Aged
  • Prognosis
  • Risk

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