title: Effect of graft source on unrelated donor hemopoietic stem cell transplantation in adults with acute myeloid leukemia after reduced-intensity or nonmyeloablative conditioning: a study from the Société Francaise de Greffe de Moelle et de Thérapie Cellulaire.
abstract: This retrospective report compared the 4-year outcomes of allogeneic stem cell transplantation (allo-SCT) in 651 adult patients with acute myeloid leukemia receiving a reduced-intensity (RIC) or nonmyeloablative conditioning (NMA) regimen according to the type of unrelated donors. These were either umbilical cord blood (UCB, n = 205), a 9/10 mismatched unrelated donor (MisMUD, n = 99), or a 10/10 matched unrelated donor (MUD, n = 347) graft. Neutrophil recovery was slower in UCB (74.5% by day 42) compared with MisMUD (94.8%) and MUD (95.6%) (P < .001). There was no significant difference in nonrelapse mortality between UCB and both MUD (hazard ratio [HR], 1.05; 95% confidence interval [CI], .62 to 1.78; P = .85) and MisMUD (HR, 1.58; 95% CI, .88 to 2.83; P = .13) The relapse/progression was similar between UCB and MisMUD (HR, .62; 95% CI, .37 to 1.03; P = .07), but was significantly lower in MUD compared with UCB (HR, .60; 95% CI, .39 to .92; P = .02). The rate of extensive chronic graft-versus-host disease (GVHD) was similar between UCB and both MUD (HR, 2.15; 95% CI, .93 to 4.97; P = .08) and MisMUD (HR, 1.84; 95% CI, .68 to 4.95; P = .23). The rate of severe grade III and IV acute GVHD was significantly increased in MisMUD compared with UCB (HR, 2.61; 95% CI, 1.30 to 5.23; P = .007). There was no significant difference in overall survival between UCB and both MisMUD (HR, .98; 95% CI, .66 to 1.45; P = .92) and MUD (HR, .74; 95% CI, .52 to 1.03; P = .08). These data suggest that in the setting of RIC/NMA, allo-SCT UCB is a valid alternative graft source, with significantly less chronic GVHD, compared with MisMUD, when there is no MUD available or when urgent transplantation is needed.
authors.affiliation: Hematology Department, Nantes Hospital and University Center (CHU), Nantes, France; INSERM UMR 938 and Pierre et Marie Curie University, Paris, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Malard
authors.affiliation: Hematology and Cell Therapy Department, University Hospital and University of Bordeaux, Bordeaux, France.
authors.forename: Noel
authors.initials: N
authors.lastname: Milpied
authors.affiliation: Blood and Marrow Transplantation Program, Hematology Department, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.affiliation: Hematology Department, Nantes Hospital and University Center (CHU), Nantes, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Chevallier
authors.affiliation: Hematology Department, Groupement Hospitalier Sud, Hospices Civils de Lyon, Claude Bernard Lyon EST University, Pierre Bénite, France.
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.affiliation: Department of Hematology, Hautepierre Hospital, Strasbourg, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lioure
authors.affiliation: Department of Hematology, Nancy CHU, UTMA, Vandoeuvre-lès-Nancy, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Clément
authors.affiliation: Hematology Department, Montpellier CHU, Montpellier, France.
authors.forename: Yosr
authors.initials: Y
authors.lastname: Hicheri
authors.affiliation: Department of Hematology, AP-HP, Henri Mondor Hospital, and University Paris-Est-Creteil, Créteil, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Cordonnier
authors.affiliation: Hematology Department, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Huynh
authors.affiliation: Bone Marrow Transplantation Unit, Lille CHU, Lille, France.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yakoub-Agha
authors.affiliation: Blood and Marrow Transplantation Unit, Saint-Louis Hospital, AP-HP, Paris, France.
authors.forename: Regis
authors.initials: R
authors.lastname: Peffault de Latour
authors.affiliation: INSERM UMR 938 and Pierre et Marie Curie University, Paris, France; Hematology Department, AP-HP, Saint Antoine Hospital, Paris, France. Electronic address: mohamad.mohty@inserm.fr.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D005602:France; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000235:genetics / Q000276:immunology / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D035781:Siblings; D012955:Societies, Medical; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D061349:Unrelated Donors
chemical_list: D019653:Myeloablative Agonists
keywords: 10/10 Matched unrelated donor; 9/10 Mismatched unrelated donor; Acute myeloid leukemia; Allogeneic stem cell transplantation; Nonmyeloablative conditioning; Reduced-intensity conditioning; Umbilical cord blood