title: Outcomes after Umbilical Cord Blood Transplantation for Myelodysplastic Syndromes.
abstract: For patients with hematologic malignancies undergoing allogeneic hematopoietic cell transplantation, umbilical cord blood transplantation (UCBT) has become an acceptable alternative donor source in the absence of a matched sibling or unrelated donor. To date, however, there have been few published series dedicated solely to describing the outcomes of adult patients with myelodysplastic syndrome (MDS) who have undergone UCBT. Between 2004 and 2013, 176 adults with MDS underwent UCBT as reported to the Center for International Blood and Marrow Transplant Research. Median age at the time of transplantation was 56 years (range, 18-73 years). The study group included 10% with very low, 23% with low, 19% with intermediate, 19% with high, and 13% with very high-risk Revised International Prognostic Scoring System (IPSS-R) scores. The 100-day probability of grade II-IV acute graft-versus-host disease (GVHD) was 38%, and the 3-year probability of chronic GVHD was 28%. The probabilities of relapse and transplantation-related mortality (TRM) at 3 years were 32% and 40%, respectively, leading to a 3-year disease-free survival (DFS) of 28% and an overall survival (OS) of 31%. In multivariate analysis, increasing IPSS-R score at the time of HCT was associated with inferior TRM (P = .0056), DFS (P = .018), and OS (P = .0082), but not with GVHD or relapse. The presence of pretransplantation comorbidities was associated with TRM (P = .001), DFS (P = .02), and OS (P = .001). Reduced-intensity conditioning was associated with increased risk of relapse (relative risk, 3.95; 95% confidence interval, 1.78-8.75; P < .001), and although a higher proportion of myeloablative UCBTs were performed in patients with high-risk disease, the effect of conditioning regimen intensity was the same regardless of IPSS-R score. For some individuals who lack a matched sibling or unrelated donor, UCBT can result in long-term DFS; however, the success of UCBT in this population is hampered by a high rate of TRM.
authors.affiliation: Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: gerdsa@ccf.org.
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Gerds
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Kwang
authors.initials: K
authors.lastname: Woo Ahn
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Zhen-Huan
authors.initials: ZH
authors.lastname: Hu
authors.affiliation: Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California.
authors.forename: Hisham
authors.initials: H
authors.lastname: Abdel-Azim
authors.affiliation: Stem Cell Transplantation and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
authors.forename: Gorgun
authors.initials: G
authors.lastname: Akpek
authors.affiliation: Department of Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Aljurf
authors.affiliation: Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Karen K
authors.initials: KK
authors.lastname: Ballen
authors.affiliation: Division of Hematology and Oncology, University of Miami, Miami, Florida.
authors.forename: Amer
authors.initials: A
authors.lastname: Beitinjaneh
authors.affiliation: Department of Hematology, Inselspital Bern, Bern, Switzerland; Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Bacher
authors.affiliation: Department of Hematology, University Hospital, Grenoble, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Cahn
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Chhabra
authors.affiliation: Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Corey
authors.initials: C
authors.lastname: Cutler
authors.affiliation: Tom Baker Cancer Center, Calgary, Alberta, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Daly
authors.affiliation: Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Zachariah
authors.initials: Z
authors.lastname: DeFilipp
authors.affiliation: Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom.
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.affiliation: Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
authors.forename: Usama
authors.initials: U
authors.lastname: Gergis
authors.affiliation: Levine Cancer Institute, Charlotte, North Carolina.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Grunwald
authors.affiliation: Department of Hematology/Oncology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hale
authors.affiliation: Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
authors.forename: Betty Ky
authors.initials: BK
authors.lastname: Hamilton
authors.affiliation: Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Madan
authors.initials: M
authors.lastname: Jagasia
authors.affiliation: Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas.
authors.forename: Rammurti T
authors.initials: RT
authors.lastname: Kamble
authors.affiliation: Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Tamila
authors.initials: T
authors.lastname: Kindwall-Keller
authors.affiliation: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Taiga
authors.initials: T
authors.lastname: Nishihori
authors.affiliation: Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Olsson
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, Massachusetts.
authors.forename: Muthalagu
authors.initials: M
authors.lastname: Ramanathan
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Ayman A
authors.initials: AA
authors.lastname: Saad
authors.affiliation: The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia.
authors.forename: Melhem
authors.initials: M
authors.lastname: Solh
authors.affiliation: Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Celalettin
authors.initials: C
authors.lastname: Ustun
authors.affiliation: Department of Hematology, Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Valcárcel
authors.affiliation: Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Erica
authors.initials: E
authors.lastname: Warlick
authors.affiliation: Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington.
authors.forename: Baldeep M
authors.initials: BM
authors.lastname: Wirk
authors.affiliation: Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Matt
authors.initials: M
authors.lastname: Kalaycio
authors.affiliation: Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Edwin
authors.initials: E
authors.lastname: Alyea
authors.affiliation: M.D. Anderson Cancer Center, Houston, Texas.
authors.forename: Uday
authors.initials: U
authors.lastname: Popat
authors.affiliation: Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ronald
authors.initials: R
authors.lastname: Sobecks
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Wael
authors.initials: W
authors.lastname: Saber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality*; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011336:Probability; D012008:Recurrence; D018570:Risk Assessment; D016019:Survival Analysis; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D055815:Young Adult
keywords: Blood and marrow transplantation; Myelodysplastic syndrome; Umbilical cord transplantation