title: Outcomes of UCB transplantation are comparable in FLT3+ AML: results of CIBMTR, EUROCORD and EBMT collaborative analysis.
abstract: Allogeneic hematopoietic cell transplantation (HCT) from siblings or unrelated donors (URD) during complete remission (CR) may improve leukemia-free survival (LFS) in FMS-like tyrosine kinase 3+ (FLT3+) acute myeloid leukemia (AML), which has poor prognosis because of high relapse rates. Umbilical cord blood (UCB) HCT outcomes are largely unknown in this population. We found that compared with sibling HCT, relapse risks were similar after UCB (n=126) (hazard ratio (HR) 0.86, P=0.54) and URD (n=91) (HR 0.81, P=0.43). UCB HCT was associated with statistically higher non-relapse mortality compared with sibling HCT (HR 2.32, P=0.02), but not vs URD (HR 1.72, P=0.07). All three cohorts had statistically nonsignificant 3-year LFS: 39% (95% confidence interval (CI): 30-47) after UCB, 43% (95% CI: 30-54) after sibling and 50% (95% CI: 40-60) after URD. Chronic graft-versus-host disease rates were significantly lower after UCB compared with either sibling (HR 0.59, P=0.03) or URD (HR 0.49, P=0.001). Adverse factors for LFS included high leukocyte count at diagnosis and HCT during CR2 (second CR). UCB is a suitable option for adults with FLT3+ AML in the absence of an human leukocyte antigen-matched sibling and its immediate availability may be particularly important for FLT3+ AML where early relapse is common, thus allowing HCT in CR1 (first CR) when outcomes are best.
authors.affiliation: Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA.
authors.forename: C
authors.initials: C
authors.lastname: Ustun
authors.affiliation: Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.|Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Giannotti
authors.affiliation: CIBMTR (Center for International Blood and Marrow Transplantation), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.|Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Zhang
authors.affiliation: CIBMTR (Center for International Blood and Marrow Transplantation), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: H-L
authors.initials: HL
authors.lastname: Wang
authors.affiliation: University of Minnesota Medical Center Fairview, Minneapolis, MN, USA.
authors.forename: C
authors.initials: C
authors.lastname: Brunstein
authors.affiliation: European Group for Blood and Marrow Transplantation, Leiden, The Netherlands.|Sorbonne Universites, Centre de Recherche (CDR), Saint Antoine, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Labopin
authors.affiliation: Churchill Hospital, Oxford, UK.
authors.forename: V
authors.initials: V
authors.lastname: Rocha
authors.affiliation: Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: M
authors.initials: M
authors.lastname: de Lima
authors.affiliation: Centre Hospitalier Universitaire de LiFge, Domaine Universityaire du Sart Tilman, Leige, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Baron
authors.affiliation: Division of Medical Oncology, University of Washington and Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: B M
authors.initials: BM
authors.lastname: Sandmaier
authors.affiliation: CIBMTR (Center for International Blood and Marrow Transplantation), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: M
authors.initials: M
authors.lastname: Eapen
authors.affiliation: Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France.|Monacord, Centre Scientifique de Monaco, Monaco.
authors.forename: E
authors.initials: E
authors.lastname: Gluckman
authors.affiliation: The Bone Marrow Transplantation Department, Division of Internal Medicine, The Chaim Sheba Medical Center, Ramat-Gan, Israel.|Sheba Cord Blood Bank, Rama-Gan, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Nagler
authors.affiliation: Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Weisdorf
authors.affiliation: Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.|Eurocord, APHP, University Paris Diderot, Hôpital Saint Louis, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Ruggeri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000517:prevention & control*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning; D061349:Unrelated Donors; D055815:Young Adult