title: Impact of minimal residual disease on outcomes after umbilical cord blood transplantation for adults with Philadelphia-positive acute lymphoblastic leukaemia: an analysis on behalf of Eurocord, Cord Blood Committee and the Acute Leukaemia working party of the European group for Blood and Marrow Transplantation.
abstract: The status of umbilical cord blood transplantation (UCBT) in adults with Philadelphia-positive acute lymphoblastic leukaemia (Ph+ALL) and the impact of minimal residual disease (MRD) before transplant are not well established. We analysed 98 patients receiving UCBT for Ph+ALL in first (CR1) or second (CR2) complete remission (CR1, n = 79; CR2, n = 19) with MRD available before UCBT (92% analysed by reverse transcription polymerase chain reaction). Median age was 38 years and median follow-up was 36 months; 63% of patients received myeloablative conditioning and 42% received double-unit UCBT. Eighty-three patients were treated with at least one tyrosine kinase inhibitor before UCBT. MRD was negative (-) in 39 and positive (+) in 59 patients. Three-year cumulative incidence of relapse was 34%; 45% in MRD+ and 16% in MRD- patients (P =0·013). Three-year cumulative incidence of non-relapse mortality was 31%; it was increased in patients older than 35 years (P = 0·02). Leukaemia-free survival (LFS) at 3 years was 36%; 27% in MRD+ and 49% in MRD- patients (P = 0·05), and 41% for CR1 and 14% for CR2 (P = 0·008). Multivariate analysis identified only CR1 as being associated with improved LFS. In conclusion, MRD+ before UCBT is associated with increased relapse. Strategies to decrease relapse in UCBT recipients with Ph+ALL and MRD+ are needed.
authors: Eurocord APHP, University Paris-Diderot, Hospital Saint Louis, Paris, France; Centro de Oncologia, Hospital Sirio Libanes, Sao Paulo, Brazil.
authors: Luciana
authors: L
authors: Tucunduva
authors: Annalisa
authors: A
authors: Ruggeri
authors: Guillermo
authors: G
authors: Sanz
authors: Sabine
authors: S
authors: Furst
authors: Jan
authors: J
authors: Cornelissen
authors: Werner
authors: W
authors: Linkesch
authors: Lionel
authors: L
authors: Mannone
authors: Josep-Maria
authors: JM
authors: Ribera
authors: Hendrik
authors: H
authors: Veelken
authors: Ibrahim
authors: I
authors: Yakoub-Agha
authors: Maria Elvira
authors: ME
authors: González Valentín
authors: Rik
authors: R
authors: Schots
authors: William
authors: W
authors: Arcese
authors: Pau
authors: P
authors: Montesinos
authors: Myriam
authors: M
authors: Labopin
authors: Eliane
authors: E
authors: Gluckman
authors: Mohamad
authors: M
authors: Mohty
authors: Vanderson
authors: V
authors: Rocha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: acute lymphoblastic leukaemia; adult; cord blood transplantation; minimal residual disease