title: Outcomes of Cord Blood Transplantation Using Reduced-Intensity Conditioning for Chronic Lymphocytic Leukemia: A Study on Behalf of Eurocord and Cord Blood Committee of Cellular Therapy and Immunobiology Working Party, Chronic Malignancies Working Party of the European Society for Blood and Marrow Transplantation, and the Societé Française de Greffe de Moelle et Therapie Cellulaire.
abstract: Outcomes after umbilical cord blood transplantation (UCBT) for chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) are unknown. We analyzed outcomes of 68 patients with poor-risk CLL/SLL who underwent reduced-intensity (RIC) UCBT from 2004 to 2012. The median age was 57 years and median follow-up 36 months; 17 patients had del 17p/p53mutation, 19 patients had fludarabine-refractory disease, 11 relapsed after autologous stem cell transplantation, 8 had diagnosis of prolymphocytic leukemia, 4 had Richter syndrome, and 8 underwent transplantation with progressive or refractory disease. The most common RIC used was cyclophosphamide, fludarabine, and total body irradiation (TBI) in 82%; 15 patients received antithymocyte globulin. Most of the cord blood grafts were HLA mismatched and 76% received a double UCBT. Median total nucleated cells collected was 4.7 × 10(7)/kg. The cumulative incidences (CI) of neutrophil and platelet engraftment were 84% and 72% at 60 and 180 days respectively; day 100 graft-versus-host disease (GVHD) (grade II to IV) was 43% and 3-year chronic GVHD was 32%. The CI of relapse, nonrelapse mortality, overall survival, and progression-free survival (PFS) at 3 years were 16%, 39%, 54%, and 45%, respectively. Fludarabine-sensitive disease at transplantation and use of low-dose TBI regimens were associated with acceptable PFS. In conclusion, use of RIC-UCBT seems to be feasible in patients with poor-risk CLL/SLL and improved outcomes were observed in patients with fludarabine-sensitive disease who received low-dose TBI regimens.
authors.affiliation: Eurocord International Registry, Hôpital Saint-Louis, Paris, France. Electronic address: erick_menezes@yahoo.com.
authors.forename: Erick
authors.initials: E
authors.lastname: Xavier
authors.affiliation: Department of Hematology, Cancer Institute Lucien Neuwirth, Saint Etienne, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Cornillon
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: Department of Hematology, Nantes University Hospital, Nantes, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Chevallier
authors.affiliation: Department of Hematology, Erasmus MC/Daniel Den Hoed, Rotterdam, Netherlands.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Cornelissen
authors.affiliation: Department of Hematology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Niels S
authors.initials: NS
authors.lastname: Andersen
authors.affiliation: Service Oncologie Hématologique et Thérapie Cellulaire, CHU de Poitiers, Poitiers, France.
authors.forename: Natacha
authors.initials: N
authors.lastname: Maillard
authors.affiliation: Department of Hematology, Pitie-Salpetriere Hospital, Paris, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nguyen
authors.affiliation: Department of Hematology, Paoli Calmettes Hospital, Marseille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.affiliation: Department of Hematology, Jean Minjoz Hospital, Besançon, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Deconinck
authors.affiliation: Department of Hematology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Veelken
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: Department Internal Medicine/Hematology, Maastricht University Medical Center, Maastricht, Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: Van Gelder
authors.affiliation: Blood and Marrow Transplantation Unit, Saint Louis Hospital, Paris, France.
authors.forename: Regis
authors.initials: R
authors.lastname: Peffault de Latour
authors.affiliation: Eurocord International Registry, Hôpital Saint-Louis, Paris, France.
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
authors.affiliation: University Hospital Carl Gustav Carus, Medical Department & DKMS German Bone Marrow Donor Center, Dresden, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Schetelig
authors.affiliation: Department of Clinical Haematology, Bone Marrow Transplantation Unit, Oxford University Hospitals NHS Trust, United Kingdom.
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
mesh_terms: D000328:Adult; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D018572:Disease-Free Survival; D005060:Europe; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: Chronic lymphocytic leukemia; Reduced-intensity conditioning regimen; Umbilical cord blood transplantation