Factors Associated with Outcome After Cord Blood Transplantation in Children with Acute Leukemia. Eurocord-Cord Blood Transplant Group
Overview
Authors
Affiliations
We have analyzed factors influencing the outcome of 102 children with acute leukemia given a cord blood transplantation (CBT) and reported to the Eurocord Registry. Seventy patients with acute lymphoblastic and 32 with acute myeloid leukemia were given either a related (n = 42) or an unrelated (n = 60) CBT. Children given CBT during first or second complete remission were considered as belonging to the good-risk group (n = 66), whereas those who received a transplant in a more advanced stage of disease were assigned to the poor-risk group (n = 36). In the related group (RCBT), 12 of 42 patients received transplantation from an HLA-disparate donor, whereas in the unrelated group (UCBT) 54 of 60 received an HLA mismatched CBT. Kaplan-Meier estimates for neutrophil recovery at day 60 were 84% +/- 7% in RCBT and 79 +/- 6% in UCBT (P =.16). In multivariate analysis, the most important factor influencing neutrophil engraftment in UCBT was a nucleated cell dose infused greater than 3.7 x 10(7)/kg (P =.05, relative risk [RR] of 1.85, 95% confidence interval [CI]: 0.98-3.4). The incidence of grade II through IV acute graft-versus-host disease was 41% +/- 8% in the RCBT group and 37% +/- 6% in the UCBT group (P =.59). Kaplan-Meier estimates of 2-year event-free survival (EFS) after RCBT or UCBT were 39% +/- 8% and 30% +/- 7%, respectively (P =.19). In multivariate analysis, the most important factor influencing EFS was disease status at time of transplantation: good-risk patients had a 2-year EFS of 49% +/- 7% as compared to 8% +/- 5% in patients with more advanced disease (P =.0003, RR: 0.40, 95% CI: 0.24 to 0. 65). This was a consequence of both an increased 1-year transplant related mortality and a higher 2-year relapse rate in the poor-risk group (65% +/- 9% and 77% +/- 14%, respectively), as compared with good risk patients (34% +/- 6% and 31% +/- 9%, respectively). These data confirm that allogeneic CBT from either a related or an unrelated donor is a feasible procedure able to cure a significant proportion of children with acute leukemia, especially if transplanted in a favorable phase of disease.
Unrelated Donor Cord Blood Transplantation in Children: Lessons Learned Over 3 Decades.
Kurtzberg J, Troy J, Page K, El Ayoubi H, Volt F, Scigliuolo G Stem Cells Transl Med. 2023; 12(1):26-38.
PMID: 36718114 PMC: 9887081. DOI: 10.1093/stcltm/szac079.
Ishida H, Yano M, Hasegawa D, Hori T, Hashii Y, Kato K Int J Hematol. 2021; 113(6):893-902.
PMID: 33641058 DOI: 10.1007/s12185-021-03110-0.
Shouval R, Nagler A Stem Cell Investig. 2017; 4:39.
PMID: 28607913 PMC: 5460098. DOI: 10.21037/sci.2017.05.06.
Novel Techniques for Ex Vivo Expansion of Cord Blood: Clinical Trials.
Mehta R, Rezvani K, Olson A, Oran B, Hosing C, Shah N Front Med (Lausanne). 2015; 2:89.
PMID: 26697430 PMC: 4675847. DOI: 10.3389/fmed.2015.00089.
Umbilical cord blood graft engineering: challenges and opportunities.
Thompson P, Rezvani K, Hosing C, Oran B, Olson A, Popat U Bone Marrow Transplant. 2015; 50 Suppl 2:S55-62.
PMID: 26039209 DOI: 10.1038/bmt.2015.97.