title: Comparison of umbilical cord blood allogeneic stem cell transplantation vs. auto-SCT for adult acute myeloid leukemia patients in second complete remission at transplant: a retrospective study on behalf of the SFGM-TC.
abstract: This retrospective study considered the outcomes of 181 patients with acute myeloid leukemia (AML) transplanted in second complete remission (CR2) between January 2005 and April 2012 and who received either a myeloablative autologous stem cell transplant (Auto-SCT; n = 82; median age: 48 years; median follow-up: 45 months) or an umbilical cord blood (UCB) allogeneic SCT (n = 99, median age: 46 years; median follow-up: 36 months; conditioning regimens: myeloablative n = 21, reduced n = 78; single unit n = 37, double units n = 62). Although the Auto group showed a significant better prognostic profile at transplant, with longer median interval between diagnosis and time of graft, higher incidence of good-risk cytogenetics and lower number of previously transplanted patients, 3-year OS and LFS were similar between both groups (Auto: 59 ± 6% vs. 50 ± 6%, P = 0.45; and 57 ± 6% vs. 46 ± 6%, P = 0.37). In multivariate analysis, UCB allo-SCT was associated with lower relapse incidence (HR: 0.3, 95% CI: 0.11-0.82, P = 0.02), but higher non-relapse mortality (NRM) (HR: 4.16; 95% CI: 1.46-11.9, P = 0.008). Results from this large study suggest that UCB allo-SCT provides better disease control than auto-SCT, which is especially important in the setting of high-risk disease. However, this disease control advantage is counterbalanced by higher toxicity, highlighting the need for novel approaches aiming to decrease NRM after UCB allo-SCT.
authors.affiliation: Centre Hospitalier et Universitaire (CHU) de Nantes, Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie (CI2C), Université de Nantes and INSERM CRNCA UMR 892, Nantes, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Chevallier
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.forename: Gerard
authors.initials: G
authors.lastname: Socie
authors.forename: Marie-There
authors.initials: MT
authors.lastname: Rubio
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.forename: Stephane
authors.initials: S
authors.lastname: Vigouroux
authors.forename: Anne
authors.initials: A
authors.lastname: Huynh
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.forename: Jacques-Olivier
authors.initials: JO
authors.lastname: Bay
authors.forename: Sébastien
authors.initials: S
authors.lastname: Maury
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yakoub-Agha
authors.forename: Nathalie
authors.initials: N
authors.lastname: Fegueux
authors.forename: Eric
authors.initials: E
authors.lastname: Deconinck
authors.forename: Nathalie
authors.initials: N
authors.lastname: Contentin
authors.forename: Natacha
authors.initials: N
authors.lastname: Maillard
authors.forename: Claude-Eric
authors.initials: CE
authors.lastname: Bulabois
authors.forename: Sylvie
authors.initials: S
authors.lastname: Francois
authors.forename: Reman
authors.initials: R
authors.lastname: Oumedaly
authors.forename: Nicole
authors.initials: N
authors.lastname: Raus
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
chemical_list: D000970:Antineoplastic Agents
keywords: SFGM-TC; acute myeloid leukemia; autologous stem cell transplant; second complete remission; umbilical cord blood allogeneic stem cell transplantation