Comparison of Outcomes of 8/8 and 7/8 Allele-Matched Unrelated Bone Marrow Transplantation and Single-Unit Cord Blood Transplantation in Adults with Acute Leukemia

Seitaro Terakura; Yoshiko Atsuta; Nobuhiro Tsukada; Takeshi Kobayashi; Masatsugu Tanaka; Junya Kanda; Yuho Najima; Takahiro Fukuda; Naoyuki Uchida; Satoshi Takahashi; Tokiko Nagamura-Inoue; Yasuo Morishima; Koichi Miyamura; Japan Society for Hematopoietic Cell Transplantation

doi:10.1016/j.bbmt.2015.10.006

Comparison of Outcomes of 8/8 and 7/8 Allele-Matched Unrelated Bone Marrow Transplantation and Single-Unit Cord Blood Transplantation in Adults with Acute Leukemia

Biol Blood Marrow Transplant. 2016 Feb;22(2):330-338. doi: 10.1016/j.bbmt.2015.10.006. Epub 2015 Oct 22.

Affiliations

¹ Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: tseit@med.nagoya-u.ac.jp.
² Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.
³ Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan.
⁴ Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
⁵ Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan.
⁶ Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
⁷ Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
⁸ Department of Hematology, Toranomon Hospital, Tokyo, Japan.
⁹ Division of Molecular Therapy, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
¹⁰ Department of Cell Processing and Transfusion, Research Hospital, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
¹¹ Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan.
¹² Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.

PMID: 26476205
DOI: 10.1016/j.bbmt.2015.10.006

Abstract

To investigate an up-to-date alternative donor selection strategy, we compared the transplantation outcomes of 8/8 and 7/8 allele-matched unrelated bone marrow transplantation (UBMT) with those of umbilical cord blood transplantation (UCBT) and redefined the role of UCBT with extended analysis. Using Cox and competing risk regression analyses, we analyzed the transplantation outcomes in adult patients with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). A total of 2472 first myeloablative transplantations between 2000 and 2010 were included (8/8 UBMT, 1001; 7/8 UBMT, 656; UCBT, 815). For acute and chronic graft-versus-host disease (GVHD) and nonrelapse mortality (NRM), we applied the combined analyses including both AML and ALL data. In the multivariate analyses, severe acute GVHD and NRM after UCBT were comparable with 8/8 UBMT, whereas those after 7/8 UBMT were significantly higher. The incidence of extensive chronic GVHD was significantly lower with UCBT compared with after 8/8 and 7/8 UBMT. With adjusted analyses for AML, UCBT and 8/8 UBMT showed similar overall survival (OS), whereas 7/8 UBMT showed inferior OS. For ALL, we found no significant difference in OS among the 3 groups. Cord blood may be the first choice alternative to 8/8 UBMT for both AML and ALL.

Keywords: Bone marrow transplantation; Graft source; Umbilical cord blood transplantation; Unrelated volunteer donor.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Alleles
Bone Marrow Transplantation / methods*
Cord Blood Stem Cell Transplantation / methods*
Female
Humans
Leukemia, Myeloid, Acute / therapy*
Male
Middle Aged
Treatment Outcome
Young Adult