Single- vs double-unit cord blood transplantation for children and young ă adults with acute leukemia or myelodysplastic syndrome

Abstract : Transplantation of 2 unrelated cord blood (UCB) units instead of 1 has ă been proposed to increase the cell dose. We report a prospective ă randomized study, designed to compare single-vs double-UCB ă transplantation in children and young adults with acute leukemia in ă remission or myelodysplasia. Eligible patients had at least two 4-6 ă HLA-identical UCBs with >3x10(7) nucleated cells/kg for the first and ă >1.5x10(7) for the second. The primary end point was the 2-year ă cumulative incidence of transplantation strategy failure, a composite ă end point including transplant-related mortality (TRM), engraftment ă failure, and autologous recovery. Randomized patients who did not ă proceed to transplantation due to refractory disease were considered ă transplantation failures. A total of 151 patients were randomized and ă included in the intent-to-treat analysis; 137 were transplanted. ă Double-UCB transplantation did not decrease transplantation strategy ă failure (23.4% 6 4.9% vs 14.9% +/- 4.2%). Two-year posttransplant ă survival, disease-free survival, and TRM were 68.8% +/- 6.0%, 67.6% ă +/- 6.0%, and 5.9% +/- 2.9% after single-unit transplantation ă compared with 74.8% +/- 5.5%, 68.1% +/- 6.0%, and 11.6% +/- 3.9% ă after double-unit transplantation. The final relapse risk did not ă significantly differ, but relapses were delayed after double-unit ă transplantation. Overall incidences of graft-versus-host disease (GVHD) ă were similar, but chronic GVHD was more frequently extensive after ă double-UCB transplantation (31.9% +/- 5.7% vs 14.7% +/- 4.3%, ă P=.02). In an exploratory subgroup analysis, we found a significantly ă lower relapse risk after double-unit transplantation in patients ă receiving total body irradiation without antithymocyte globulin (ATG), ă whereas the relapse risk was similar in the group treated with busulfan, ă cyclophosphamide, and ATG. Single-UCB transplantation with adequate cell ă dose remains the standard of care and leads to low TRM. Double-unit ă transplantation should be reserved for patients who lack such units. ă This trial was registered at www. clinicaltrials. gov as #NCT01067300.
Keywords : Quality
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Soumis le : vendredi 3 mars 2017 - 16:02:37
Dernière modification le : dimanche 15 octobre 2017 - 22:44:12



Gerard Michel, Claire Galambrun, Anne Sirvent, Cécile Pochon, Bénédicte Bruno, et al.. Single- vs double-unit cord blood transplantation for children and young ă adults with acute leukemia or myelodysplastic syndrome. Blood, American Society of Hematology, 2016, 127 (26), pp.3450-3457. 〈10.1182/blood-2016-01-694349〉. 〈hal-01482531〉



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