title: Unrelated bone marrow transplantation or immediate umbilical cord blood transplantation for patients with acute myeloid leukemia in first complete remission.
abstract: BACKGROUND
  While unrelated bone marrow transplantation (UBMT) has been widely used as alternative donor transplantation, the use of umbilical cord blood transplantation (UCBT) is increasing recently.
  
  
  METHODS
  We conducted a decision analysis to address which transplantation procedure should be prioritized for younger patients with acute myeloid leukemia (AML) harboring high- or intermediate-risk cytogenetics in first complete remission (CR1), when they lack a matched related donor but have immediate access to a suitable umbilical cord blood unit. Main sources for our analysis comprised the data from three phase III trials for a chemotherapy cohort (n = 907) and the registry data for a transplantation cohort (n = 752).
  
  
  RESULTS
  The baseline analysis showed that when the 8/8 match was considered for UBMT, the expected 5-year survival rate was higher for UBMT than for UCBT (58.1% vs. 51.8%). This ranking did not change even when the 7/8 match was considered for UBMT. Sensitivity analysis showed consistent superiority of UBMT over UCBT when the time elapsed between CR1 and UBMT was varied within a plausible range of 3-9 months.
  
  
  CONCLUSIONS
  These results suggest that 8/8 or 7/8 UBMT is a better transplantation option than UCBT even after allowing time required for donor coordination.
authors.affiliation: Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Yanada
authors.affiliation: Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Kanda
authors.affiliation: Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Ohtake
authors.affiliation: National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fukuda
authors.affiliation: Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.affiliation: Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Miyamura
authors.affiliation: Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan.|Saiseikai Maebashi Hospital, Maebashi, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Miyawaki
authors.affiliation: Toranomon Hospital, Tokyo, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Uchida
authors.affiliation: Saitama International Medical Center, Saitama Medical University, Hidaka, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Maeda
authors.affiliation: The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
authors.forename: Tokiko
authors.initials: T
authors.lastname: Nagamura-Inoue
authors.affiliation: Saitama International Medical Center, Saitama Medical University, Hidaka, Japan.|Kumamoto University School of Medicine, Kumamoto, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Asou
authors.affiliation: Aichi Cancer Center Research Institute, Nagoya, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Morishima
authors.affiliation: Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.|Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Atsuta
authors.affiliation: Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miyazaki
authors.affiliation: National Defense Medical College, Tokorozawa, Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Kimura
authors.affiliation: National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: Aichi Medical University, Nagakute, Japan.
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Takami
authors.affiliation: Nagoya University Graduate School of Medicine, Nagoya, Japan.|National Hospital Organization Nagoya Medical Center, Nagoya, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Naoe
authors.affiliation: Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods; D000066491:Clinical Decision-Making; D017326:Clinical Trials, Phase III as Topic; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012074:Remission Induction; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: acute myeloid leukemia; decision analysis; first complete remission; umbilical cord blood transplantation; unrelated bone marrow transplantation