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Ma L, Han X, Jiang S, Meng Q, Zhang L, Bao H. Haploidentical stem cell transplantation vs matched unrelated donor transplantation in adults with hematologic malignancies: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2021; 25:356-365. [PMID: 33054609 DOI: 10.1080/16078454.2020.1831292] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Haploidentical hematopoietic stem cell transplantation (Haplo-SCT) and matched unrelated donor transplantation (MUD-SCT) are two important options when a matched sibling donor (MSD) is unavailable. Several studies comparing Haplo-SCT and MUD-SCT have reported inconsistent clinical outcomes. Therefore, it is necessary to synthesize the existing evidence regarding outcomes of stem cell transplantations comparing Haplo-SCT with MUD-SCT. METHODS We searched for titles of articles in MEDLINE (PubMed), Cochrane library, EMBASE database that compared transplantation with Haplo-SCT versus MUD-SCT. To compare clinical outcomes between Haplo-SCT and MUD-SCT, we performed a meta-analysis of 17 studies and reported the pooled odd ratios (OR) of 6 endpoints including overall survival (OS), progression free survival (PFS), non-relapse mortality (NRM), relapse rate (RR), acute graft-versus-host disease (aGVHD) and chronic graft- versus-host disease (cGVHD). RESULTS We found that Haplo-SCT was associated with a comparable OS (pooled OR of 0.99, 95% Confidence Interval (CI) 0.86-1.14), PFS (OR 1.00, 95% CI 0.88-1.15), NRM (OR 0.83, 95% CI 0.65-1.04) and RR (OR 1.08, 95% CI 0.95-1.22) compared to MUD-SCT. We also found a significantly decreased risk of aGVHD (OR 0.74, 95% CI 0.62-0.88) and cGVHD (OR 0.50, 95% CI 0.38-0.66) in Haplo-SCT group. CONCLUSION Results of this meta-analysis demonstrates that Haplo-SCT achieves comparable clinical outcomes compared to MUD-SCT in terms of OS, PFS, TRM and RR, but is better than MUD-SCT in terms of decreased aGVHD and cGVHD risk. Haplo-SCT is a valid option for patient needing urgent transplantation.
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Affiliation(s)
- Liyuan Ma
- Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, 121# Jiangjiayuan Road, Nanjing 210011, People's Republic of China
| | - Xue Han
- Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, 121# Jiangjiayuan Road, Nanjing 210011, People's Republic of China
| | - Suyu Jiang
- Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, 121# Jiangjiayuan Road, Nanjing 210011, People's Republic of China
| | - Qingqi Meng
- Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, 121# Jiangjiayuan Road, Nanjing 210011, People's Republic of China
| | - Liubo Zhang
- Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, 121# Jiangjiayuan Road, Nanjing 210011, People's Republic of China
| | - Hongyu Bao
- Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, 121# Jiangjiayuan Road, Nanjing 210011, People's Republic of China
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Unlicensed Umbilical Cord Blood Units Provide a Safe and Effective Graft Source for a Diverse Population: A Study of 2456 Umbilical Cord Blood Recipients. Biol Blood Marrow Transplant 2019; 26:745-757. [PMID: 31756539 DOI: 10.1016/j.bbmt.2019.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 12/16/2022]
Abstract
Umbilical cord blood (UCB) transplantation (UCBT) is a curative procedure for patients with hematologic malignancies and genetic disorders and expands access to transplantation for non-Caucasian patients unable to find a fully matched unrelated donor. In 2011, the US Food and Drug Administration required that unrelated UCBT be performed using either licensed UCB or unlicensed UCB under the Investigational New Drug (IND) program. The National Marrow Donor Program manages an IND under which 2456 patients (1499 adults and 957 children, 564 with malignant diseases and 393 with nonmalignant diseases) underwent single or double UCBT between October 2011 and December 2016. The median patient age was 31 years (range, <1 to 81 years), and 50% of children and 36% of adults were non-Caucasian. The median time to neutrophil engraftment (ie, absolute neutrophil count ≥500/mm3) was 22 days for adults, 20 days for pediatric patients with malignant diseases, and 19 days for pediatric patients with nonmalignant diseases, with corresponding rates of engraftment at 42 days of 89%, 88%, and 90%. In these 3 groups of patients, the incidence of acute graft-versus-host disease (GVHD) grade II-IV was 35%, 32%, and 24%; the incidence of chronic GVHD was 24%, 26%, and 24%; and 1-year overall survival (OS) was 57%, 71%, and 79%, respectively. In multivariate analysis, younger age, lower Hematopoietic Cell Transplantation-Specific Comorbidity Index, early-stage chemotherapy-sensitive disease, and higher performance score were predictive of improved OS for adults. In a subset analysis of children with malignancies undergoing single UCBT, the use of either licensed UCB (n = 48) or unlicensed UCB (n = 382) was associated with similar engraftment and survival. The use of unlicensed UCB units is safe and effective and provides an important graft source for a diverse population.
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3
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Haploidentical vs. unrelated allogeneic stem cell transplantation for acute lymphoblastic leukemia in first complete remission: on behalf of the ALWP of the EBMT. Leukemia 2019; 34:283-292. [DOI: 10.1038/s41375-019-0544-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/30/2019] [Accepted: 06/14/2019] [Indexed: 01/31/2023]
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4
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Baron F, Ruggeri A, Beohou E, Labopin M, Sanz G, Milpied N, Michallet M, Bacigalupo A, Blaise D, Sierra J, Socié G, Cornelissen JJ, Schmid C, Giebel S, Gorin NC, Esteve J, Ciceri F, Savani BN, Mohty M, Gluckman E, Nagler A. RIC versus MAC UCBT in adults with AML: A report from Eurocord, the ALWP and the CTIWP of the EBMT. Oncotarget 2018; 7:43027-43038. [PMID: 27250025 PMCID: PMC5190005 DOI: 10.18632/oncotarget.9599] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/14/2016] [Indexed: 01/08/2023] Open
Abstract
Nonrelapse mortality (NRM) is the first cause of treatment failure after unrelated cord blood transplantation (UCBT) following myeloablative conditioning (MAC). In the last decade, reduced-intensity conditioning (RIC) regimens have been developed with the aim of reducing NRM and allowing older patients and those with medical comorbidities to benefit from UCBT. The aim of the current retrospective study was to compare transplantation outcomes of acute myeloid leukemia (AML) patients given UCBT after either RIC or MAC. Data from 894 adults with AML receiving a single or double UCBT as first allograft from 2004 to 2013 at EBMT centers were included in this study. 415 patients were given UCBT after RIC while 479 patients following a MAC. In comparison to MAC recipients, RIC recipients had a similar incidence of neutrophil engraftment and of acute and chronic graft-versus-host disease (GVHD). However, RIC recipients had a higher incidence of disease relapse and a lower NRM, translating to comparable leukemia-free (LFS), GVHD-free, relapse-free survival (GRFS) and overall survival (OS). These observations remained qualitatively similar after adjusting for differences between groups in multivariate analyses. In conclusion, these data suggest that LFS and OS are similar with RIC or with MAC in adults AML patients transplanted with UCBT. These observations could serve as basis for a future prospective randomized study.
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Affiliation(s)
| | - Annalisa Ruggeri
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France.,AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Eric Beohou
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Myriam Labopin
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Guillermo Sanz
- Hospital Universitario La Fe, Servicio de Hematologia, Valencia, Spain
| | - Noel Milpied
- CHU Bordeaux, Hématologie Clinique et Thérapie Cellulaire-Hôpital Haut-leveque, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | | | | | - Didier Blaise
- Institut Paoli Calmettes (IPC), Aix Marseille University (AMU), UM105, Centre de Recherche en Cancerologie (CRCM), Inserm U1068, CNRS UMR7258 Marseille, Marseille, France
| | - Jorge Sierra
- Hospital Santa Creu i Sant Pau, Hematology Department, Barcelona, Spain
| | - Gérard Socié
- AP-HP, Hematology Transplantation, Hospital Saint-Louis, Paris, France
| | - Jan J Cornelissen
- Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Christoph Schmid
- Klinikum Augsburg, Department of Hematology and Oncology, University of Munich, Augsburg, Germany
| | - Sebastian Giebel
- Maria Sklodowska-Curie Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Norbert-Claude Gorin
- AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France.,EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Jordi Esteve
- Deptartment of Hematology, Hospital Clinic, Barcelona, Spain
| | - Fabio Ciceri
- Department of Hematology, Ospedale San Raffaele, Università degli Studi, Milano, Italy
| | - Bipin N Savani
- Long Term Transplant Clinic, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mohamad Mohty
- AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France.,Universite Pierre & Marie Curie, Paris, France.,INSERM, UMRS 938, Paris, France
| | - Eliane Gluckman
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, France Monacord, Centre Scientifique de Monaco, Monaco
| | - Arnon Nagler
- EBMT Paris Office, Hospital Saint Antoine, Paris, France.,Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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Umbilical Cord Blood Cytomegalovirus Serostatus Does Not Have an Impact on Outcomes of Umbilical Cord Blood Transplantation for Acute Leukemia. Biol Blood Marrow Transplant 2017; 23:1729-1735. [DOI: 10.1016/j.bbmt.2017.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/28/2017] [Indexed: 01/27/2023]
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6
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Baron F, Ruggeri A, Beohou E, Labopin M, Mohty M, Blaise D, Cornelissen JJ, Chevallier P, Sanz G, Petersen E, Savani BN, Gluckman E, Nagler A. Single- or double-unit UCBT following RIC in adults with AL: a report from Eurocord, the ALWP and the CTIWP of the EBMT. J Hematol Oncol 2017. [PMID: 28637512 PMCID: PMC5479038 DOI: 10.1186/s13045-017-0497-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background The feasibility of cord blood transplantation (CBT) in adults is limited by the relatively low number of hematopoietic stem/progenitor cells contained in one single CB unit. The infusion of two CB units from different partially HLA-matched donors (double CBT) is frequently performed in patients who lack a sufficiently rich single CB unit. Methods We compared CBT outcomes in patients given single or double CBT following reduced-intensity conditioning (RIC) in a retrospective multicenter registry-based study. Inclusion criteria included adult (≥18 years) patients, acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL), complete remission (CR) at the time of transplantation, first single (with a cryopreserved TNC ≥ 2.5 × 107/kg) or double CBT between 2004 and 2014, and RIC conditioning. Results Data from 534 patients with AML (n = 408) or ALL (n = 126) receiving a first single (n = 172) or double (n = 362) CBT were included in the analyses. In univariate analysis, in comparison to patients transplanted with a single CB, double CB recipients had a similar incidence of neutrophil engraftment but a suggestion for a higher incidence of grade II–IV acute GVHD (36 versus 28%, P = 0.08). In multivariate analyses, in comparison to single CBT recipients, double CBT patients had a comparable incidence of relapse (HR = 0.9, P = 0.5) and of nonrelapse mortality (HR = 0.8, P = 0.3), as well as comparable overall (HR = 0.8, P = 0.17), leukemia-free (HR = 0.8, P = 0.2) and GVHD-free, relapse-free (HR = 1.0, P = 0.3) survival. Conclusions These data failed to demonstrate better transplantation outcomes in adult patients receiving double CBT in comparison to those receiving single CBT with adequate TNC after RIC. Electronic supplementary material The online version of this article (doi:10.1186/s13045-017-0497-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frédéric Baron
- Department of Hematology, University of Liege, CHU Sart-Tilman, 4000, Liege, Belgium.
| | - Annalisa Ruggeri
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France.,AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Eric Beohou
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Myriam Labopin
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Mohamad Mohty
- AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Didier Blaise
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - Jan J Cornelissen
- Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | | | - Guillermo Sanz
- Servicio de Hematologia, Hospital Universitario La Fe, Valencia, Spain
| | - Eefke Petersen
- Department of Hematology, University Medical Centre, Utrecht, The Netherlands
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eliane Gluckman
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, France Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Arnon Nagler
- EBMT Paris Office, Hospital Saint Antoine, Paris, France.,Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel and the EBMT Paris Office, Hospital Saint Antoine, Paris, France
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7
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Santoro N, Ruggeri A, Labopin M, Bacigalupo A, Ciceri F, Gülbaş Z, Huang H, Afanasyev B, Arcese W, Wu D, Koc Y, Tischer J, Santarone S, Giebel S, Mohty M, Nagler A. Unmanipulated haploidentical stem cell transplantation in adults with acute lymphoblastic leukemia: a study on behalf of the Acute Leukemia Working Party of the EBMT. J Hematol Oncol 2017; 10:113. [PMID: 28558762 PMCID: PMC5450162 DOI: 10.1186/s13045-017-0480-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/19/2017] [Indexed: 01/12/2023] Open
Abstract
Background Allogenic hematopoietic stem cell transplantation (allo-SCT) is the most effective post-remission treatment for adults with high-risk acute lymphoblastic leukemia (ALL). The aim of the study was to analyze results of unmanipulated haploidentical allo-SCT (haplo-SCT) for adults with ALL and to identify prognostic factors. Methods We performed a retrospective analysis on 208 adults transplanted in EBMT centers from 2007 to 2014. Results Median age at haplo-SCT was 32 years and median follow-up, 31 months. Forty-four percent of the patients were in first complete remission (CR1). Stem cell source was the bone marrow (BM) for 43% and peripheral blood (PB) for 57% of patients. Myeloablative conditioning (MAC) was used for 66% and reduced intensity regimen (RIC) for 34% of patients. GVHD prophylaxis was based on post-transplant cyclophosphamide (PT-Cy) for 118 (57%) or on anti-thymocyte-globulin (ATG) for 90 (43%) plus standard prophylaxis. One hundred eighty-four (92%) patients achieved engraftment. Cumulative incidence (CI) of grade II–IV acute-graft-versus-host-disease (GVHD) was 31%, grade III–IV 11%, and chronic GVHD 29%. Non-relapse mortality (NRM) and relapse-incidence (RI) were 32 and 37%, respectively. Overall survival (OS), leukemia-free survival (LFS), and GVHD-free, relapse-free-survival (GRFS) at 3 years were 33, 31, and 26%. For patients in CR1, OS, LFS, and GRFS were 52, 47, and 40%, respectively. Disease status was the main factor associated with transplant outcomes. Use of BM was independently associated with improvement in NRM, acute GVHD, GRFS, LFS, and OS. Conclusions Unmanipulated haplo-SCT may be considered a valid option for adult patients with high-risk ALL lacking HLA identical donor preferably in early disease status. Electronic supplementary material The online version of this article (doi:10.1186/s13045-017-0480-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicole Santoro
- Department of Hematology and Cell Therapy, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France. .,Department of Medicine, Division of Hematology and Clinical Immunology, University of Perugia, Perugia, Italy.
| | - Annalisa Ruggeri
- Department of Hematology and Cell Therapy, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France
| | - Myriam Labopin
- Department of Hematology and Cell Therapy, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France.,ALWP office, Hôpital Saint-Antoine, Paris, France
| | - Andrea Bacigalupo
- Department of Hematology II, Ospedale San Martino, Genova, Italy.,Università cattolica del Sacro Cuore, Roma, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Zafer Gülbaş
- Hematology Department, Anadolu Medical Center Hospital, Kocaeli, Turkey
| | - He Huang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, School of Medicine, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Boris Afanasyev
- Hematology and Transplantology, Ratsa Gorbacheva Memorial Children's Institute, Saint Petersburg State Medical Pavlov University, St. Petersburg, Russian Federation
| | - William Arcese
- Stem Cell Transplant Unit, Department of Hematology, Tor Vergata "University Hospital", Rome, Italy
| | - Depei Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yener Koc
- Stem Cell Transplant Unit, Medical Park Hospitals, Antalya, Turkey
| | - Johanna Tischer
- Department of Internal Medicine III, Hematopoietic Stem Cell Transplantation, Ludwig-Maximilians-University Hospital of Munich-Grosshadern, Munich, Germany
| | - Stella Santarone
- Department of Hematology and Trasfusional Medicine, Lund University, Ospedale Civile, Pescara, Italy
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Onco-Hematology, Comprehensive Cancer Center M. Sklodowska-Curie Memorial Institute, Gliwice Branch, Gliwice, Poland
| | - Mohamad Mohty
- Department of Hematology and Cell Therapy, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint Antoine, 75012, Paris, France
| | - Arnon Nagler
- ALWP office, Hôpital Saint-Antoine, Paris, France.,Department of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Aviv, Israel
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8
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Shouval R, Nagler A. From patient centered risk factors to comprehensive prognostic models: a suggested framework for outcome prediction in umbilical cord blood transplantation. Stem Cell Investig 2017; 4:39. [PMID: 28607913 DOI: 10.21037/sci.2017.05.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 05/10/2017] [Indexed: 12/23/2022]
Abstract
Prospectively identifying patients who will gain maximal benefit from umbilical cord blood transplantation (UCBT) with minimal risk is a desirable unmet need. A complex network of parameters related to patient, disease, donor, and procedure all come into play. We review the prognostic role of patient-related risk factors in adults undergoing UCBT. Furthermore, since comprehensive prognostic models are lacking in UCBT, we suggest a framework for integrating patients' features in the development of prediction models for UCBT outcomes. Such models could contribute to patient selection, optimization of the various modifiable features in the process of UCBT, analysis of retrospective data, and design of interventions.
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Affiliation(s)
- Roni Shouval
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Acute Leukemia Working Party-Paris Office, Hospital Saint-Antoine, EBMT, Paris, France
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9
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Optimal Practices in Unrelated Donor Cord Blood Transplantation for Hematologic Malignancies. Biol Blood Marrow Transplant 2017; 23:882-896. [PMID: 28279825 DOI: 10.1016/j.bbmt.2017.03.006] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/02/2017] [Indexed: 12/26/2022]
Abstract
Unrelated donor cord blood transplantation (CBT) results in disease-free survival comparable to that of unrelated adult donor transplantation in patients with hematologic malignancies. Extension of allograft access to racial and ethnic minorities, rapid graft availability, flexibility of transplantation date, and low risks of disabling chronic graft-versus-host disease (GVHD) and relapse are significant advantages of CBT, and multiple series have reported a low risk of late transplantation-related mortality (TRM) post-transplantation. Nonetheless, early post-transplantation morbidity and TRM and the requirement for intensive early post-transplantation management have slowed the adoption of CBT. Targeted care strategies in CBT recipients can mitigate early transplantation complications and reduce transplantation costs. Herein we provide a practical "how to" guide to CBT for hematologic malignancies on behalf of the National Marrow Donor Program and the American Society of Blood and Marrow Transplantation's Cord Blood Special Interest Group. It shares the best practices of 6 experienced US transplantation centers with a special interest in the use of cord blood as a hematopoietic stem cell source. We address donor search and unit selection, unit thaw and infusion, conditioning regimens, immune suppression, management of GVHD, opportunistic infections, and other factors in supportive care appropriate for CBT. Meticulous attention to such details has improved CBT outcomes and will facilitate the success of CBT as a platform for future graft manipulations.
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10
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Arai Y, Kondo T, Shigematsu A, Tanaka J, Takahashi S, Kobayashi T, Uchida N, Onishi Y, Ishikawa J, Kanamori H, Sawa M, Yokota A, Kouzai Y, Takanashi M, Ichinohe T, Atsuta Y, Mizuta S. High-dose cytarabine added to CY/TBI improves the prognosis of cord blood transplantation for acute lymphoblastic leukemia in adults: a retrospective cohort study. Bone Marrow Transplant 2016; 51:1636-1639. [PMID: 27643870 DOI: 10.1038/bmt.2016.242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Y Arai
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - A Shigematsu
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - J Tanaka
- Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan
| | - S Takahashi
- Division of Molecular Therapy, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - T Kobayashi
- Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - N Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan
| | - Y Onishi
- Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai, Japan
| | - J Ishikawa
- Department of Hematology and Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - H Kanamori
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - M Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan
| | - A Yokota
- Department of Hematology, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Y Kouzai
- Department of Transfusion Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | - M Takanashi
- Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - T Ichinohe
- Department of Hematology and Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Y Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S Mizuta
- Division of Hematology, Fujita Health University, Toyoake, Japan
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11
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Rocha V. Umbilical cord blood cells from unrelated donor as an alternative source of hematopoietic stem cells for transplantation in children and adults. Semin Hematol 2016; 53:237-245. [PMID: 27788761 DOI: 10.1053/j.seminhematol.2016.08.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 01/13/2023]
Abstract
Umbilical cord blood (CB) is an alternative source of hematopoietic stem cells (HSC) for patients requiring allogeneic HSC transplantation but lacking a suitable human leukocyte antigen (HLA)-matched donor. Using CB has many advantages, including lower HLA-matching requirements, increased donor availability, and low rates of graft-versus-host disease. Furthermore, with over 630,000 cryopreserved volunteer CB units currently stored in international CB banks worldwide, CB is rapidly available for those patients requiring urgent transplantation. However, concern remains over the low HSC doses available in CB grafts, resulting in delayed engraftment and poor immune reconstitution. This article reviews the current use and future developments of unrelated allogeneic CB transplantation (CBT). An overview of the encouraging results of CBT and the comparisons with other HSC sources and transplant strategies both in children and adults with malignant and non-malignant diseases are shown. We will discuss important factors that need to be considered when selecting CB units for transplantation to further improve the results of CBT.
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Affiliation(s)
- Vanderson Rocha
- Department of Haematology, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, United Kingdom; NHS Blood and Transplant, Oxford Centre, John Radcliffe Hospital, Oxford, United Kingdom; Eurocord, Hôpital Saint Louis APHP, University Paris VII IUH Paris, France; Department of Hematology, University of São Paulo, São Paulo, Brazil.
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Aldoss I, Tsai NC, Slovak ML, Palmer J, Alvarnas J, Marcucci G, Forman SJ, Pullarkat V. Cytogenetics Does Not Impact Outcomes in Adult Patients with Acute Lymphoblastic Leukemia Undergoing Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2016; 22:1212-1217. [DOI: 10.1016/j.bbmt.2016.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 03/23/2016] [Indexed: 12/12/2022]
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Impact of KIR/HLA genetic combinations on double umbilical cord blood transplantation outcomes. Results of a French multicentric retrospective study on behalf of the Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC) and the Société Francophone d'Histocompatibilité et d'Immunogénétique (SFHI). Bone Marrow Transplant 2016; 51:1499-1503. [PMID: 27272444 DOI: 10.1038/bmt.2016.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia in Adults. Curr Hematol Malig Rep 2016; 11:175-84. [DOI: 10.1007/s11899-016-0317-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative treatment for patients with hematological diseases. The probability of finding a human leukocyte antigen (HLA)- identical donor among family members is around 25% and 30% that of having a full matched unrelated donor in the registry. Patients in need may also benefit of a HLA-mismatched HSCT either from an haploidentical donors or from umbilical cord blood (UCB). Much has been learned about UCB transplant (UCBT) since the first human UCBT was performed back in 1988. Cord blood banks have been established worldwide for the collection, cryopreservation, and distribution of UCB for HSCT. Today, a global network of cord blood banks and transplant centers has been established with a large common inventory of more than 650,000 UCB units available, allowing for more than 40,000 UCBT worldwide in children and adults with severe hematological diseases. Several studies have been published on UCBT, assessing risk factors such as cell dose and HLA mismatch. Outcomes of several retrospective comparative studies showed similar results using other stem cell sources both in pediatric and adult setting. New strategies are ongoing to facilitate engraftment and reduce transplant-related mortality. In this issue, we review the current results of UCBT in adults with hematological malignancies and the clinical studies comparing UCBT with other transplant strategies. We provide guidelines for donor algorithm selection in UCBT setting.
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Affiliation(s)
- Annalisa Ruggeri
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, Eurocord, Hôpital Saint Louis, Paris, France.
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Baron F, Labopin M, Ruggeri A, Mohty M, Sanz G, Milpied N, Bacigalupo A, Rambaldi A, Bonifazi F, Bosi A, Sierra J, Yakoub-Agha I, Santasusana JMR, Gluckman E, Nagler A. Unrelated cord blood transplantation for adult patients with acute myeloid leukemia: higher incidence of acute graft-versus-host disease and lower survival in male patients transplanted with female unrelated cord blood--a report from Eurocord, the Acute Leukemia Working Party, and the Cord Blood Committee of the Cellular Therapy and Immunobiology Working Party of the European Group for Blood and Marrow Transplantation. J Hematol Oncol 2015; 8:107. [PMID: 26445106 PMCID: PMC4594748 DOI: 10.1186/s13045-015-0207-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/28/2015] [Indexed: 12/18/2022] Open
Abstract
Background In the setting of allogeneic human leukocyte antigen (HLA)-matched bone marrow transplantation, transplanting male patients with grafts from female donors has been associated with a higher incidence of graft-versus-host disease (GVHD) and of nonrelapse mortality (NRM). The aim of the current analysis was to compare transplantation outcomes in male patients given female unrelated cord blood (UCB) versus other gender combinations. Patients and methods Data from 552 consecutive patients with acute myeloid leukemia (AML) given a single UCB transplantation between 2000 and 2014 were included. Results In comparison with other gender combination, male patients given female UCB (n = 131) had a trend for a higher incidence of grades II–IV acute GVHD (33 versus 25 %, P = 0.08), a trend for a higher incidence of NRM (41 versus 33 %, P = 0.06), and a lower leukemia-free (LFS, 30 versus 41 %, P = 0.01) and overall survival (OS, 33 versus 45 %, P = 0.008). In multivariate analyses, taking into consideration all patients for which data on HLA-matching and cell dose transplanted were fully available (n = 363), male patients transplanted with a female UCB had a trend for a higher incidence of grade III–IV acute GVHD (hazard ratio (HR) = 2.0, P = 0.06), a trend for a higher NRM (HR = 1.5, P = 0.06), and a worse LFS (HR = 1.4, P = 0.04) and OS (HR = 1.3, P = 0.06). Conclusions Our data suggest that male patients transplanted with female UCB might have higher risk of acute GVHD and of NRM leading to worse LFS and OS. These results should be confirmed in other large cohorts of patients before used for determining the choice of an UCB unit. Electronic supplementary material The online version of this article (doi:10.1186/s13045-015-0207-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frédéric Baron
- Department of Hematology, University of Liège, CHU Sart-Tilman, 4000, Liège, Belgium.
| | - Myriam Labopin
- EBMT Paris Office, Hospital Saint Antoine, Paris, France.
| | - Annalisa Ruggeri
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France. .,AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France.
| | - Mohamad Mohty
- AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France.
| | - Guillermo Sanz
- Hospital Universitario La Fe - Servicio de Hematologia, Valencia, Spain.
| | - Noel Milpied
- CHU Bordeaux - Hôpital Haut-leveque, Pessac, France.
| | | | - Alessandro Rambaldi
- Azienda Ospedaliera Papa Giovanni XXIII-Hematology and Bone Marrow Transplant Unit, Bergamo, Italy.
| | - Francesca Bonifazi
- Institute of Hematology and Medical, Oncology L and A Seràgnoli, S.Orsola-Malpighi Hospital, Bologna University, Bologna, Italy.
| | - Alberto Bosi
- BMT Unit Department of Hematology, Ospedale di Careggi, Firenze, Italy.
| | - Jorge Sierra
- Hematology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain.
| | | | | | - Eliane Gluckman
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, France Monacord, Centre Scientifique de Monaco, Monaco, Monaco.
| | - Arnon Nagler
- EBMT Paris Office, Hospital Saint Antoine, Paris, France. .,Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.
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Zhu H, Zhang Y, Jin H, Wang Y, Shao X, Kong J, Huang W, Hong Y, Li C, Gao F, Chen L, Wang F, Lu Y. [Clinical study on 137 cases of unrelated single unit umbilical cord blood hematopoietic stem cell transplantation]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:140-3. [PMID: 25778891 PMCID: PMC7342165 DOI: 10.3760/cma.j.issn.0253-2727.2015.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate relevant prognostic factors of unrelated single unit umbilical cord blood hematopoietic stem cell transplantation (sUCBT), and to explore the correlation between cryopreservation time of cord blood and cell viability and outcome of sUCBT. METHODS Retrospective analysis of 137 patients undergoing sUCBT with cord blood provided by Shanghai Cord Blood Bank from Mar. 15, 2007 to Dec. 26, 2013 were performed in this study. The mean cryopreservation time of 137 units cord blood was 698(96-1968) days, with mean cell viability of 87.4% after thawing. RESULTS No statistical difference on cell viability, hematopoietic reconstitution, graft failure, acute graft versus host disease (GVHD) and overall survival (OS) was found between patients transfused with cord blood preserved below and above 2 years. The 5-year OS of patients transfused with cord blood preserved below and above 2 years were 55.6% and 67.9%, respectively (P=0.124). OS of the UCBT at 2011 and before, and after 2011 was 48.7% and 79.6%, respectively (P=0.001). Age above 16-year-old (RR=2.830, P=0.027) and UCBT at 2011 and before (RR=0.203, P<0.001) were two risk factors of treatment related mortality. CONCLUSION Outcome of sUCBT in China had significant improvement in recent 2 years. Cryopreservation time of cord blood had no statistical correlation to cell viability after thawing and clinical outcome.
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Affiliation(s)
- Hua Zhu
- Shanghai Cord Blood Bank, Shanghai Stem Cell Technology Co., LTD., Shanghai 200051, China
| | - Yi Zhang
- Shanghai Cord Blood Bank, Shanghai Stem Cell Technology Co., LTD., Shanghai 200051, China
| | - Huanying Jin
- Shanghai Cord Blood Bank, Shanghai Stem Cell Technology Co., LTD., Shanghai 200051, China
| | - Yinting Wang
- Shanghai Cord Blood Bank, Shanghai Stem Cell Technology Co., LTD., Shanghai 200051, China
| | - Xiayan Shao
- Shanghai Cord Blood Bank, Shanghai Stem Cell Technology Co., LTD., Shanghai 200051, China
| | - Jingsi Kong
- Shanghai Cord Blood Bank, Shanghai Stem Cell Technology Co., LTD., Shanghai 200051, China
| | - Wenhao Huang
- Shanghai Cord Blood Bank, Shanghai Stem Cell Technology Co., LTD., Shanghai 200051, China
| | - Yan Hong
- Shanghai Cord Blood Bank, Shanghai Stem Cell Technology Co., LTD., Shanghai 200051, China
| | - Chunli Li
- Shanghai Cord Blood Bank, Shanghai Stem Cell Technology Co., LTD., Shanghai 200051, China
| | - Feng Gao
- Shanghai Cord Blood Bank, Shanghai Stem Cell Technology Co., LTD., Shanghai 200051, China
| | - Liang Chen
- Shanghai Cord Blood Bank, Shanghai Stem Cell Technology Co., LTD., Shanghai 200051, China
| | - Feng Wang
- Shanghai Cord Blood Bank, Shanghai Stem Cell Technology Co., LTD., Shanghai 200051, China
| | - Yao Lu
- Shanghai Cord Blood Bank, Shanghai Stem Cell Technology Co., LTD., Shanghai 200051, China
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