title: Results of a prospective multicentre myeloablative double-unit cord blood transplantation trial in adult patients with acute leukaemia and myelodysplasia.
abstract: Double-unit cord blood (CB) grafts may improve engraftment and relapse risk in adults with haematological malignancies. We performed a prospective high-dose myeloablative double-unit CB transplantation (CBT) trial in adults with high-risk acute leukaemia or myelodysplasia (MDS) between 2007 and 2011. The primary aim was to establish the 1-year overall survival in a multi-centre setting. Fifty-six patients (31 acute myeloid leukaemia, 19 acute lymphoblastic leukaemia, 4 other acute leukaemias, 2 myelodysplastic syndrome [MDS]) were transplanted at 10 centres. The median infused total nucleated cell doses were 2·62 (larger unit) and 2·02 (smaller unit) x 10(7) /kg. The cumulative incidence of day 100 neutrophil engraftment was 89% (95% confidence interval [CI]: 80-96). Day 180 grade II-IV acute graft-versus-host disease (GVHD) incidence was 64% (95%CI: 51-76) and 36% (95%CI: 24-49) of patients had chronic GVHD by 3-years. At 3-years post-transplant, the transplant-related mortality (TRM) was 39% (95%CI: 26-52), and the 3-year relapse incidence was 11% (95%CI: 4-21). With a median 37-month (range 23-71) follow-up of survivors, the 3-year disease-free survival was 50% (95%CI: 37-63). Double-unit CBT is a viable alternative therapy for high-risk acute leukaemia/ MDS in patients lacking a matched unrelated donor. This is especially important for minority patients. The relapse incidence was low but strategies to ameliorate TRM are needed.
authors.affiliation: Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Barker
authors.forename: Mingwei
authors.initials: M
authors.lastname: Fei
authors.forename: Chatchada
authors.initials: C
authors.lastname: Karanes
authors.forename: Mitchell
authors.initials: M
authors.lastname: Horwitz
authors.forename: Steven
authors.initials: S
authors.lastname: Devine
authors.forename: Tamila L
authors.initials: TL
authors.lastname: Kindwall-Keller
authors.forename: Jennifer
authors.initials: J
authors.lastname: Holter
authors.forename: Alexia
authors.initials: A
authors.lastname: Adams
authors.forename: Brent
authors.initials: B
authors.lastname: Logan
authors.forename: Willis H
authors.initials: WH
authors.lastname: Navarro
authors.forename: Marcie
authors.initials: M
authors.lastname: Riches
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001792:Blood Platelets / Q000473:pathology; D005312:Fetal Blood / Q000637:transplantation*; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007938:Leukemia / Q000276:immunology / Q000628:therapy*; D018655:Lymphocyte Count; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000276:immunology / Q000628:therapy*; D009504:Neutrophils / Q000473:pathology; D011446:Prospective Studies; D012008:Recurrence; D019172:Transplantation Conditioning / Q000379:methods; D055815:Young Adult
keywords: acute leukaemia; adult cord blood transplantation; double cord; relapse; transplant-related mortality