Alternative donor hematopoietic stem cell transplantation for mature lymphoid malignancies after reduced-intensity conditioning regimen: similar outcomes with umbilical cord blood and unrelated donor peripheral blood

Celso Arrais Rodrigues (1, 2) , Vanderson Rocha (3, 4, 2) , Peter Dreger (5) , Claudio Brunstein (6) , Henrik Sengeloev (7) , Jürgen Finke (8) , Mohamad Mohty (9, 10, 11, 12) , Bernard Rio (9) , Eefke Petersen (13) , Francois Guilhot (14) , Dietger Niederwieser (15) , Jan J. Cornelissen (16) , Pavel Jindra (17) , Arnon Nagler (18) , Nathalie Fegueux (19) , Hélène Schoemans (20) , Stephen Robinson (21) , Annalisa Ruggeri (4) , Eliane Gluckman (4) , Carmen Canals (22) , Anna Sureda (23, 22)

1 USP - Universidade de São Paulo = University of São Paulo
2 Hospital Sírio-Libanês
3 Churchill Hospital
4 Eurocord
5 Heidelberg University Hospital [Heidelberg]
6 UMN - University of Minnesota [Twin Cities]
7 Rigshospitalet [Copenhagen]
8 University Hospital Freiburg
9 CHU Saint-Antoine [AP-HP]
10 CHU Nantes - Centre Hospitalier Universitaire de Nantes
11 UPMC - Université Pierre et Marie Curie - Paris 6
12 UMRS893 - Centre de Recherche Saint-Antoine
13 University Medical Center [Utrecht]
14 INSERM - CHU de Poitiers - INSERM CIC 0802
15 Leipzig University / Universität Leipzig
16 ErasmusMC
17 Charles University Hospital Pilsen
18 Chaim Sheba Medical Center
19 CHU - Hôpital Lapeyronie [Montpellier]
20 University Hospitals Leuven [Leuven]
21 Avon haematology unit Bristol
22 Hospital de la Santa Creu i Sant Pau
23 Addenbrooke's Hospital

We have reported encouraging results of unrelated cord blood transplantation for patients with lymphoid malignancies. Whether those outcomes are comparable to matched unrelated donor transplants remains to be defined. We studied 645 adult patients with mature lymphoid malignancies who received an allogeneic unrelated donor transplant using umbilical cord blood (n=104) or mobilized peripheral blood stem cells (n=541) after a reduced-intensity conditioning regimen. Unrelated cord blood recipients had more refractory disease. Median follow-up time was 30 months. Neutrophil engraftment (81% vs. 97%, respectively; P<0.0001) and chronic graft-versus-host disease (26% vs. 52%; P=0.0005) were less frequent after unrelated cord blood than after matched unrelated donor, whereas no differences were observed in grade II–IV acute graft-versus-host disease (29% vs. 32%), non-relapse mortality (29% vs. 28%), and relapse or progression (28% vs. 35%) at 36 months. There were also no significant differences in 2-year progression-free survival (43% vs. 58%, respectively) and overall survival (36% vs. 51%) at 36 months. In a multivariate analysis, no differences were observed in the outcomes between the two stem cell sources except for a higher risk of neutrophil engraftment (hazard ratio=2.12; P<0.0001) and chronic graft-versus-host disease (hazard ratio 2.10; P=0.0002) after matched unrelated donor transplant. In conclusion, there was no difference in final outcomes after transplantation between umbilical cord blood and matched unrelated donor transplant. Umbilical cord blood is a valuable alternative for patients with lymphoid malignancies lacking an HLA-matched donor, being associated with lower risk of chronic graft-versus-host disease.

Domaines: Hématologie

Celso Arrais Rodrigues, Vanderson Rocha, Peter Dreger, Claudio Brunstein, Henrik Sengeloev, et al.. Alternative donor hematopoietic stem cell transplantation for mature lymphoid malignancies after reduced-intensity conditioning regimen: similar outcomes with umbilical cord blood and unrelated donor peripheral blood. Haematologica, 2014, 99 (2), pp.370-377. ⟨10.3324/haematol.2013.088997⟩. ⟨hal-01325615⟩