title: Reduced-intensity conditioning transplantation in acute leukemia: the effect of source of unrelated donor stem cells on outcomes.
abstract: We report the relative efficacy of co-infusing 2 umbilical cord blood units (dUCB) compared with peripheral blood progenitor cells (PBPCs) from 8 of 8 or 7 of 8 HLA-matched unrelated donors. All patients received reduced-intensity conditioning (RIC) regimens. Four treatment groups were evaluated: 4-6 of 6 matched dUCB-TCF (n = 120; TCF = total body irradiation [TBI] 200 cGy + cyclophosphamide + fludarabine), 4-6 of 6 matched dUCB-other (n = 40; alkylating agent + fludarabine ± TBI), and 8 of 8 (n = 313) and 7 of 8 HLA-matched PBPCs (n = 111). Compared with matched 8 of 8 PBPC transplantations, transplantation-related mortality (TRM), and overall mortality were similar after dUCB-TCF (relative risk [RR] 0.72, P = .72; RR 0.93, P = .60) but higher after dUCB-other RIC (hazard ratio [HR] 2.70, P = .0001; 1.79 P = .004). Compared with 7 of 8 PBPC transplantations, TRM (but not overall mortality) was lower after dUCB-TCF (RR 0.57, P = .04; RR 0.87 P = .41). The probabilities of survival after dUCB-TCF, dUCB-other RIC, and 8 of 8 PBPC and 7 of 8 PBPC transplantations were 38%, 19%, 44%, and 37%, respectively. With similar survival after 8 of 8, 7 of 8 matched PBPCs, and dUCB-TCF, these data support use of dUCB-TCF transplantation in adults with acute leukemia who may benefit from RIC transplantation urgently or lack a 7-8 of 8 unrelated donor.
authors.affiliation: University of Minnesota, Minneapolis, MN 55455, USA. bruns072@umn.edu
authors.forename: Claudio G
authors.initials: CG
authors.lastname: Brunstein
authors.forename: Mary
authors.initials: M
authors.lastname: Eapen
authors.forename: Kwang Woo
authors.initials: KW
authors.lastname: Ahn
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Appelbaum
authors.forename: Karen K
authors.initials: KK
authors.lastname: Ballen
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.forename: Corey
authors.initials: C
authors.lastname: Cutler
authors.forename: Fangyu
authors.initials: F
authors.lastname: Kan
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Laughlin
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Soiffer
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: Anne
authors.initials: A
authors.lastname: Woolfrey
authors.forename: John E
authors.initials: JE
authors.lastname: Wagner
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005312:Fetal Blood / Q000637:transplantation*; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology; D006410:Hematopoiesis; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D008875:Middle Aged; D012008:Recurrence; D033581:Stem Cell Transplantation / Q000379:methods*; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D061349:Unrelated Donors; D055815:Young Adult
chemical_list: D006680:HLA Antigens