title: Risk factors for outcomes after unrelated cord blood transplantation for adults with acute lymphoblastic leukemia: a report on behalf of Eurocord and the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation.
abstract: We performed a retrospective analysis on 421 adult patients who underwent unrelated cord blood transplantation (UCBT) for ALL. Median age was 32 years; 46% were in first CR (CR1), 32% in CR2 and 22% had advanced disease. Double UCBT was performed in 173 patients (41%). Myeloablative conditioning (MAC) was given to 314 patients (75%). Cumulative incidence (CI) of 60-day neutrophil recovery was 78%. CI of acute and chronic GVHD was 33 and 26%, respectively. Non-relapse mortality (NRM) at 2 years was 42%. Age⩾35 years (P<0.0001), advanced disease at UCBT (P<0.0001) and use of MAC (P<0.0001) were associated with increased NRM. Relapse incidence (RI) at 2 years was 28%; use of reduced intensity conditioning (RIC) (P=0.0002) was associated with increased RI. Two-year leukemia-free survival (LFS) was 39% for patients in CR1, 31% for CR2 and 8% for advanced disease. In multivariate analysis, factors associated with decreased LFS rate were: age ⩾35 years (P=0.034), use of MAC (P=0.032) and advanced disease (P<0.0001). These results show that UCBT is a valuable option to treat high-risk adult ALL when in remission. Strategies to decrease toxicity and relapse are needed to improve final outcomes.
authors.affiliation: 1]  Eurocord AP-HP, University Paris-Diderot, Saint-Louis Hospital , Paris, France [2] Centro de Oncologia, Hospital Sirio Libanes, Sao Paulo, Brazil.
authors.forename: L
authors.initials: L
authors.lastname: Tucunduva
authors.affiliation: 1]  Eurocord AP-HP, University Paris-Diderot, Saint-Louis Hospital , Paris, France [2] Rome Transplant Network, University Tor Vergata, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ruggeri
authors.affiliation: Servicio de Hematologia, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Sanz
authors.affiliation: Department of Hematology, Institut Paoli Calmettes, Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Furst
authors.affiliation: Department of Hematology, Bone Marrow Transplantation Unit, Saint-Louis Hospital, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Socié
authors.affiliation: Department of Hematology, Edouard Herriot Hospital, Lyon, France.
authors.forename: M
authors.initials: M
authors.lastname: Michallet
authors.affiliation: Division of Hematology, Stem Cell Transplant Unit, University of Rome Tor Vergata, Rome, Italy.
authors.forename: W
authors.initials: W
authors.lastname: Arcese
authors.affiliation: Department of Hematology, CHU Bordeaux, Hôpital Haut-leveque, Pessac, France.
authors.forename: N
authors.initials: N
authors.lastname: Milpied
authors.affiliation: Division of Hematology, CHU de Lille, Lille, France.
authors.forename: I
authors.initials: I
authors.lastname: Yakoub-Agha
authors.affiliation: Division of Hematology, Medical University Graz, Graz, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Linkesch
authors.affiliation: Department of Hematology, Erasmus MC/Daniel Den Hoed, Rotterdam, Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Cornelissen
authors.affiliation: Service d'hématologie clinique, Hôpital de l'ARCHET, Nice, France.
authors.forename: L
authors.initials: L
authors.lastname: Mannone
authors.affiliation: Department of Cell Biotechnology and Hematology, University La Sapienza, Rome, Italy.
authors.forename: A P
authors.initials: AP
authors.lastname: Iori
authors.affiliation: Department of Hematology, ICO-Hospital Universitari Germans Trias i Pujol, Jose Carreras Research Institute, Badalona, Spain.
authors.forename: J-M
authors.initials: JM
authors.lastname: Ribera
authors.affiliation: Servicio de Hematologia, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Sanz
authors.affiliation: Servicio de Hematologia, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Montesinos
authors.affiliation: 160;Eurocord AP-HP, University Paris-Diderot, Saint-Louis Hospital , Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Purtill
authors.affiliation: Service d'Hématologie et Thérapie Cellulaire, AP-HP, UPMC Université Paris 6, UMR-S 938, CEREST-TC EBMT, Hôpital Saint Antoine, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Labopin
authors.affiliation: 160;Eurocord AP-HP, University Paris-Diderot, Saint-Louis Hospital , Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Gluckman
authors.affiliation: Service d'Hématologie et Thérapie Cellulaire, AP-HP, UPMC Université Paris 6, UMR-S 938, CEREST-TC EBMT, Hôpital Saint Antoine, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Mohty
authors.affiliation: 1]  Eurocord AP-HP, University Paris-Diderot, Saint-Louis Hospital , Paris, France [2] Centro de Oncologia, Hospital Sirio Libanes, Sao Paulo, Brazil [3] Department of Hematology, Churchill Hospital, Oxford University Hospitals, Oxford, UK.
authors.forename: V
authors.initials: V
authors.lastname: Rocha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D005060:Europe; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D061349:Unrelated Donors; D055815:Young Adult