Unrelated cord blood transplantation for childhood acute myeloid leukemia: a Eurocord Group analysis.
Results of unrelated cord blood transplantation (UCBT) in childhood acute myeloid leukemia (AML) have not been previously reported. We analyzed 95 children receiving UCB transplants for AML (20 in first complete remission [CR1], 47 in CR2, and 28 in more advanced stage). Poor prognosis cytogenetic abnormalities were identified in 29 cases. Most patients received a 1 or 2 HLA antigens-mismatched UCB transplants. The median number of collected nucleated cells (NCs) was 5.2 x 107/kg. Cumulative incidence (CI) of neutrophil recovery was 78% +/- 4%, acute graft-versus-host disease (GVHD) was 35% +/- 5%, and 100-day transplantation-related mortality (TRM) was 20% +/- 4%. In multivariable analysis, a collected NC dose higher than 5.2 x 107/kg was associated with a lower 100-day TRM. The 2-year CI of relapse was 29% +/- 5% and was associated with disease status. The 2-year leukemia-free survival (LFS) was 42% +/- 5% (59% +/- 11% in CR1, 50% +/- 8% in CR2, and 21% +/- 9% for children not in CR). Children with poor prognosis cytogenetic features had similar LFS compared with other patients (44% +/- 11% vs 40% +/- 8%). In CR2, LFS was not influenced by the length of CR1 (53% +/- 11% in CR1 < 9.5 months compared with 50% +/- 12% in later relapses). We conclude that UCBT is a therapeutic option for children with very poor-prognosis AML and who lack an HLA-identical sibling.
Michel
Gerard
G
Eurocord Registry-Hospital Saint Louis AP/HP, Department of Hematology and Bone Marrow Transplantation and Clinical Research Laboratory on Cell Therapy, Paris University 7, 1 Ave Claude Vellefaux, 75010 Paris, France.
Rocha
Vanderson
V
Chevret
Sylvie
S
Arcese
William
W
Chan
Kah-Wah
KW
Filipovich
Alexandra
A
Takahashi
Tsuneo A
TA
Vowels
Marcus
M
Ortega
Juan
J
Bordigoni
Pierre
P
Shaw
Peter J
PJ
Yaniv
Isaac
I
Machado
Alexandra
A
Pimentel
Pedro
P
Fagioli
Franca
F
Verdeguer
Amparo
A
Jouet
Jean Pierre
JP
Diez
Blanca
B
Ferreira
Euripedes
E
Pasquini
Ricardo
R
Rosenthal
Joseph
J
Sievers
Eric
E
Messina
Chiara
C
Iori
Anna Paola
AP
Garnier
Federico
F
Ionescu
Irina
I
Locatelli
Franco
F
Gluckman
Eliane
E
D000208:Acute Disease; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001772:Blood Cell Count; D001782:Blood Donors; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D036101:Cord Blood Stem Cell Transplantation / Q000401:mortality; D005060:Europe / Q000453:epidemiology; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D012042:Registries / Q000706:statistics & numerical data; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis