title: Comparison of outcomes after unrelated cord blood and unmanipulated haploidentical stem cell transplantation in adults with acute leukemia.
abstract: Outcomes after unmanipulated haploidentical stem cell transplantation (Haplo) and after unrelated cord blood transplantation (UCBT) are encouraging and have become alternative options to treat patients with high-risk acute leukemia without human leukocyte antigen (HLA) matched donor. We compared outcomes after UCBT and Haplo in adults with de novo acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). Median follow-up was 24 months. Analysis was performed separately for patients with AML, n=918 (Haplo=360, UCBT=558) and ALL, n=528 (Haplo=158 and UCBT=370). UCBT was associated with delayed engraftment and higher graft failure in both AML and ALL recipients. In multivariate analysis, UCBT was associated with lower incidence of chronic graft-vs-host disease both in the AML group (hazard ratio (HR)=0.63, P=0.008) and in the ALL group (HR=0.58, P=0.01). Not statistically significant differences were observed between Haplo and UCBT for relapse incidence (HR=0.95, P=0.76 for AML and HR=0.82, P=0.31 for ALL), non-relapse mortality (HR=1.16, P=0.47 for AML and HR=1.23, P=0.23 for ALL) and leukemia-free survival (HR 0.78, P=0.78 for AML and HR=1.00, P=0.84 for ALL). There were no statistically differences on main outcomes after unmanipulated Haplo and UCBT, and both approaches are valid for acute leukemia patients lacking a HLA matched donor. Both strategies expand the donor pool for patients in need.
authors.affiliation: Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, AP-HP, Paris, France.|INSERM, UMRs 938, Paris, France.|Hôpital Saint Louis, Eurocord, IUH University Paris VII, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Ruggeri
authors.affiliation: Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, AP-HP, Paris, France.|Hôpital Saint Antoine, Université Pierre and Marie Curie, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Labopin
authors.affiliation: Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Sanz
authors.affiliation: Hematology and BMT Unit, San Raffaele Scientific Institute, Milano, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Piemontese
authors.affiliation: Rome Transplant Network, University Tor Vergata, Rome, Italy.
authors.forename: W
authors.initials: W
authors.lastname: Arcese
authors.affiliation: Dipartimento di Ematologia, Ospedale San Martino, Genova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bacigalupo
authors.affiliation: Institut Paoli Calmettes, Marseille, France.
authors.forename: D
authors.initials: D
authors.lastname: Blaise
authors.affiliation: Careggi University Hospital, Firenze, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bosi
authors.affiliation: Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: H
authors.initials: H
authors.lastname: Huang
authors.affiliation: Evangelismos Hospital, Division of Hematology, BMT Unit, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Karakasis
authors.affiliation: Stem Cell Transplant Unit, Medical Park, Antalya, Turkey.
authors.forename: Y
authors.initials: Y
authors.lastname: Koc
authors.affiliation: Hôpital Edouard Herriot, Lyon, France.
authors.forename: M
authors.initials: M
authors.lastname: Michallet
authors.affiliation: Rome Transplant Network, University Tor Vergata, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Picardi
authors.affiliation: Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Sanz
authors.affiliation: Ospedale Civile, Dipartimento di Ematologia, BMT Unit, Pescara, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Santarone
authors.affiliation: Rigshospitalet, Copenhagen, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Sengelov
authors.affiliation: Hospital Santa Creu i Sant Pau, Jose Carreras Institute, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Sierra
authors.affiliation: CHU Montpellier, Montpellier, France.
authors.forename: L
authors.identifier: http://orcid.org/0000-0001-5904-1286
authors.initials: L
authors.lastname: Vincent
authors.affiliation: Hôpital Saint Louis, Eurocord, IUH University Paris VII, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Volt
authors.affiliation: Chaim Sheba Medical Center, Tel-Hashomer, Israel.|ALWP Office Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, AP-HP, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Nagler
authors.affiliation: Hôpital Saint Louis, Eurocord, IUH University Paris VII, Paris, France.|Monacord, Centre Scientifique de Monaco, Monaco, France.
authors.forename: E
authors.initials: E
authors.lastname: Gluckman
authors.affiliation: Hematology and BMT Unit, San Raffaele Scientific Institute, Milano, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Ciceri
authors.affiliation: Hôpital Saint Louis, Eurocord, IUH University Paris VII, Paris, France.|Churchill Hospital, Oxford University, Oxford, UK.
authors.forename: V
authors.initials: V
authors.lastname: Rocha
authors.affiliation: Hôpital Saint Antoine, Service d'Hématologie et Thérapie Cellulaire, AP-HP, Paris, France.|INSERM, UMRs 938, Paris, France.|Hôpital Saint Antoine, Université Pierre and Marie Curie, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Mohty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000276:immunology* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000276:immunology* / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012307:Risk Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006680:HLA Antigens