title: Alternative donor transplantation for older patients with acute myeloid leukemia in first complete remission: a center for international blood and marrow transplant research-eurocord analysis.
abstract: We studied patients with acute myeloid leukemia (AML) over age 50 and in first complete remission (CR1) after adult unrelated donor (URD) (n = 441, 8/8 HLA matched; n = 94, 7/8 HLA matched) or umbilical cord blood (UCB; n = 205) transplantations. UCB recipients achieved CR1 within 8 weeks less often, and received reduced-intensity conditioning and cyclosporine-based graft-versus-host disease (GVHD) prophylaxis more often. Neutrophil recovery was slower in UCB (69% by day 28) compared with 8/8 HLA-matched URD (97%) and 7/8 HLA-matched (91%) (P < .001) recipients. Three-year transplantation-related mortality (TRM) was higher and leukemia-free survival (LFS) lower with UCB (35% and 28%, respectively) versus 8/8 HLA-matched URD (27% and 39%, respectively). TRM was higher in 7/8 HLA-matched URD (41%, P = .01), but LFS was similar at 34% (P = .39). Three-year chronic GVHD was the lowest in UCB (28%) versus 53% and 59% in 8/8 and 7/8 HLA-matched URD recipients, respectively. Three-year survival was 43% in 8/8 HLA-matched URD (95% confidence interval [CI], 38% to 48%), 30% in UCB (95% CI, 23% to 37%) (P = .002) and 37% in 7/8 URD (95% CI, 27 to 46). Allotransplantation for AML in CR1 with any of these grafts extends LFS for over one third of older patients. In the absence of an 8/8 HLA-matched URD or when transplantation is needed urgently, UCB can provide extended survival. Less frequent chronic GVHD with UCB transplantation may be of particular value for older patients.
authors.affiliation: Department of Medicine, Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: weisd001@umn.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Weisdorf
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mary
authors.initials: M
authors.lastname: Eapen
authors.affiliation: Eurocord, Hopital Saint Louis, Paris, France; Service d Hematologie et Therapie Cellulaire, Hopital Saint Antoine, Paris, France.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Ruggeri
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Eurocord, Hopital Saint Louis, Paris, France; Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.affiliation: Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Zhong
authors.affiliation: Department of Medicine, Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Claudio
authors.initials: C
authors.lastname: Brunstein
authors.affiliation: Department of Medicine, Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Celalettin
authors.initials: C
authors.lastname: Ustun
authors.affiliation: Eurocord, Hopital Saint Louis, Paris, France; Oxford University Hospitals NHS Trust, Department of Clinical Haematology, Churchill Hospital, Oxford, United Kingdom.
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.affiliation: Eurocord, Hopital Saint Louis, Paris, France; Université Paris Diderot, Paris, France.
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
mesh_terms: D000367:Age Factors; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D061349:Unrelated Donors
keywords: Acute myeloid leukemia; Allogeneic transplantation; Umbilical cord blood; Unrelated donors