Long-term follow-up and factors influencing outcomes after related HLA-identical cord blood transplantation for patients with malignancies: an analysis on behalf of Eurocord-EBMT.
We analyzed risk factors influencing outcomes after related (R) human leukocyte antigen-identical cord blood transplantation (CBT) for 147 patients with malignancies reported to Eurocord-European Group for Blood and Marrow Transplantation. CBT has been performed since 1990; median follow-up was 6.7 years. Median patient age was 5 years. Acute leukemia was the most frequent diagnosis (74%). At CBT, 40 patients had early, 70 intermediate, and 37 advanced disease. CB grafts contained a median of 4.1 × 10(7)/kg total nucleated cells (TNCs) after thawing. The cumulative incidence (CI) of neutrophil recovery was 90% at day +60. CIs of acute and chronic graft-versus-host disease (GVHD) were 12% and 10% at 2 years, respectively. At 5 years, CIs of nonrelapse mortality and relapse were 9% and 47%, respectively; the probability of disease-free survival (DFS) and overall survival were 44% and 55%, respectively. Among other factors, higher TNCs infused was associated with rapid neutrophil recovery and improved DFS. The use of methotrexate as GVHD prophylaxis decreased the CI of engraftment. Patients without advanced disease had improved DFS. These results support banking and use of CB units for RCBT. Cell dose, GVHD prophylaxis not including methotrexate, and disease status are important factors for outcomes after RCBT.
Eurocord, Hôpital Saint-Louis, 1 ave Claude Vellefaux, Quadrilatère porte 5, Paris cedex 10, France. andree-laure.herr-bellon@sls.aphp.fr
Andrée-Laure
AL
Herr
Nabil
N
Kabbara
Carmem M S
CM
Bonfim
Pierre
P
Teira
Franco
F
Locatelli
Karin
K
Tiedemann
Arjan
A
Lankester
Jean-Pierre
JP
Jouet
Chiara
C
Messina
Yves
Y
Bertrand
Cristina
C
Díaz de Heredia
Christina
C
Peters
Wagnara
W
Chaves
Samir K
SK
Nabhan
Irina
I
Ionescu
Eliane
E
Gluckman
Vanderson
V
Rocha
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D019337:Hematologic Neoplasms / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000276:immunology / Q000401:mortality / Q000601:surgery; D007958:Leukocyte Count; D008297:Male; D015999:Multivariate Analysis; D009504:Neutrophils / Q000166:cytology; D012008:Recurrence; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D006680:HLA Antigens