Updated Comparison of 7/8 HLA Allele-Matched Unrelated Bone Marrow Transplantation and Single-Unit Umbilical Cord Blood Transplantation as Alternative Donors in Adults with Acute Leukemia.

Abstract

The outcomes of 7/8 allele-matched unrelated bone marrow transplantation (7/8 UBMT) and umbilical cord blood transplantation (UCBT) have been improving. We retrospectively analyzed adults with acute leukemia who underwent their first 7/8 UBMT or UCBT in Japan. Between January 2008 and December 2017, a total of 4150 patients were recorded, including 488 who underwent 7/8 UBMT and 3662 who underwent UCBT. Only 32 patients with 7/8 UBMT had graft-versus-host-disease (GVHD) high-risk HLA mismatched pairs. Overall survival at 3 years was 54% for 7/8 the UBMT group and 46% for the UCBT group, a nonsignificant difference in multivariate analysis (hazard ratio [HR], 1.01; 95% confidence interval [CI], .88 to 1.17; P = .89). The 7/8 UBMT and UCBT groups showed a similar nonrelapse mortality rate (HR, 1.16; 95% CI, .96 to 1.45; P = .16) and relapse rate (HR, .85; 95% CI, .71 to 1.02; P = .08). However, the UCBT group had a lower risk of grade II-IV acute GVHD (HR, .76; 95% CI, .65 to .88; P < .001) and chronic GVHD (HR, .77; 95% CI, .66- .91; P = .002) compared with the 7/8 UBMT group. In stratified analyses combining disease risk with conditioning intensity, 7/8 UBMT showed superior overall survival to UCBT in standard risk and myeloablative conditioning (HR, .72; 95% CI, .56 to .93; P = .014). Both 7/8 UBMT and UCBT are appropriate alternative donor procedures. The stem cell source can be selected on the basis of disease risk, patient tolerability, or concerns regarding GVHD.

• Authors: Kotaro Miyao, Seitaro Terakura, Fumihiko Kimura, Takaaki Konuma, Koichi Miyamura, Masamitsu Yanada, Shinichi Kako, Satoko Morhishima, Naoyuki Uchida, Takashi Toya, Yukiyasu Ozawa, Takahiro Fukuda, Masatsugu Tanaka, Masashi Sawa, Satoru Takada, Shuro Yoshida, Takafumi Kimura, Tatsuo Ichinohe, Yoshiko Atsuta, Junya Kanda, Donor/Source Working Group of the Japan Society for Hematopoietic Cell Transplantation
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 26 Issue 11 Pg. 2105-2114 (11 2020) ISSN: 1523-6536 [Electronic] United States
• PMID: 32784070 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Alleles
• Bone Marrow Transplantation
• Cord Blood Stem Cell Transplantation
• Graft vs Host Disease
• Humans
• Japan
• Retrospective Studies
• Unrelated Donors