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 |
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| Affiliation: | 1. Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan;2. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan;3. Division of Hematology, National Defense Medical College, Tokorozawa, Japan;4. Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan;5. Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan;6. Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan;7. Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan;8. Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Internal Medicine), Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan;9. Department of Hematology, Toranomon Hospital, Tokyo, Japan;10. Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan;11. Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan;12. Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan;13. Leukemia Research Center, Saiseikai Maebashi Hospital, Maebashi, Japan;14. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan;15. Japanese Red Cross Kinki Block Blood Center, Osaka, Japan;16. Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan;17. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan;18. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan;19. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan |
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| 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. |
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