title: Comparison of unrelated cord blood and peripheral blood stem cell transplantation in adults with myelodysplastic syndrome after reduced-intensity conditioning regimen: a collaborative study from Eurocord (Cord blood Committee of Cellular Therapy & Immunobiology Working Party of EBMT) and Chronic Malignancies Working Party.
abstract: Hematopoietic stem cell transplantation (HSCT) remains the only curative treatment in patients with higher risk myelodysplastic syndrome (MDS), but the choice of the optimal alternative stem cell source is still a subject of debate in patients lacking an HLA-matched sibling donor. Here, we report on a large series of patients with MDS (N = 631) transplanted either with mobilized peripheral stem cells (PBs) from unrelated donors (n = 502) or with umbilical cord blood transplant (UCB, n = 129) as alternative grafts after reduced-intensity conditioning. Neutrophil engraftment was higher after PB (98% versus 78%, P < .0001). Acute graft-versus-host disease (GVHD) was similar after PB (31%) and UCB (29%), and chronic GVHD incidence was higher after PB (41% versus 23%). Two-year nonrelapse mortality was lower after PB (31% versus 42% P = .03). There was a better overall survival (OS) and disease-free survival (DFS) after PB (49% ± 2% versus 30% ± 4%, P < .0001 and 44% ± 2% versus 28% ± 4%, P < .0001). Multivariate analysis confirmed the advantage of PB for treatment-related mortality, OS, and DFS, whereas relative risk of chronic GVHD was similar. A multivariate analysis comparing PB from a 10/10 HLA-matched donor, PB from a 9/10 HLA-matched donor, and UCB showed an advantage on treatment-related mortality, DFS, and OS only in 10/10 PB. We conclude that in MDS patients lacking an HLA-matched sibling donor, PB from a 10/10 HLA-matched unrelated donor is the preferred source of hematopoietic stem cells. HLA-mismatched unrelated donor or cord blood seem to give similar inferior results except for neutrophil engraftment, which is delayed after UCB.
authors.affiliation: Hematology-Bone Marrow Transplantation, Saint-Louis Hospital, Paris, France. Electronic address: marie.robin@sls.aphp.fr.
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.affiliation: Eurocord International Registry, Hôpital Saint-Louis, Paris, France; Service d'hématologie et de Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Ruggeri
authors.affiliation: EBMT Office, Hospital Saint Antoine, Universite Pierre et Marie Curie, Paris, France.
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.affiliation: Division of Hematology and Medical Oncology, University of Leipzig, Leipzig, Germany.
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.affiliation: Hôpital Haut-Lévêque, Hématologie clinique et thérapie celllulaire, Pessac Cedex, France.
authors.forename: Reza
authors.initials: R
authors.lastname: Tabrizi
authors.affiliation: Hematology Department, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Sanz
authors.affiliation: Hematology, Institut Gustave Roussy, Villejuif, France.
authors.forename: Jean-Henri
authors.initials: JH
authors.lastname: Bourhis
authors.affiliation: EBMT Clinical Trials & Study Office, Leiden, Netherlands.
authors.forename: Anja
authors.initials: A
authors.lastname: van Biezen
authors.affiliation: Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Koenecke
authors.affiliation: Hematology, Institut Paoli Calmettes, Marseille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.affiliation: Ludwig-Maximilians University of Munich, Klinikum Großhadern, Medizinische Klinik III, München, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Tischer
authors.affiliation: Center for Clinical Hematology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Charles
authors.initials: C
authors.lastname: Craddock
authors.affiliation: CHU Hematology, Poitiers, France.
authors.forename: Natacha
authors.initials: N
authors.lastname: Maillard
authors.affiliation: Service d'hématologie et de Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France; EBMT Acute Leukemia Working Party and Registry, Hospital Saint-Antoine, Paris University, Paris, France.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.affiliation: Nottingham University Hospital, Nottingham, United Kingdom.
authors.forename: Nigel
authors.initials: N
authors.lastname: Russel
authors.affiliation: Medical Clinic I, University Hospital, Dresden, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Schetelig
authors.affiliation: Department of Hematology/Oncology, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Finke
authors.affiliation: Eurocord International Registry, Hôpital Saint-Louis, Paris, France.
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
authors.affiliation: Department of Tumor Immunology, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Molecular Life Sciences, Nijmegen, Netherlands.
authors.forename: Theo M
authors.initials: TM
authors.lastname: de Witte
authors.affiliation: Eurocord International Registry, Hôpital Saint-Louis, Paris, France.
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.affiliation: Center of Oncology-Bone Marrow Transplantation Unit, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kroger
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D064591:Allografts; D036101:Cord Blood Stem Cell Transplantation; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000628:therapy; D036102:Peripheral Blood Stem Cell Transplantation; D015996:Survival Rate; D019172:Transplantation Conditioning; D061349:Unrelated Donors
keywords: Alternative donors; Cord blood transplant; Myelodysplastic syndrome; Reduced-intensity conditioning regimen