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Zhou B, Chen J, Liu T, Ye Y, Zhang Y, Ding Y, Liu H, Zhu M, Ma X, Li X, Zhao L, Lin Z, Huang H, Xu Y, Wu D. Haploidentical hematopoietic cell transplantation with or without an unrelated cord blood unit for adult acute myeloid leukemia: a multicenter, randomized, open-label, phase 3 trial. Signal Transduct Target Ther 2024; 9:108. [PMID: 38705885 PMCID: PMC11070414 DOI: 10.1038/s41392-024-01820-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 03/02/2024] [Accepted: 03/27/2024] [Indexed: 05/07/2024] Open
Abstract
Coinfusion of unrelated cord blood (UCB) units in haploidentical hematopoietic cell transplantation (haplo-HCT) (haplo-cord HCT) for hematopoietic malignancies showed promising results in previous reports, but the efficiency of haplo-cord HCT in acute myeloid leukemia (AML) still lacks sufficient evidence. This multicenter, randomized, phase 3 trial (ClinicalTrials.gov NCT03719534) aimed to assess the efficacy and safety of haplo-cord HCT in AML patients. A total of 268 eligible patients aged 18-60 years, diagnosed with measurable residual disease in AML (excluding acute promyelocytic leukemia), with available haploidentical donors and suitable for allotransplantation, were randomly allocated (1:1) to receive haplo-cord HCT (n = 134) or haplo-HCT (n = 134). The 3-year overall survival (OS) was the primary endpoint in this study. Overall median follow-up was 36.50 months (IQR 24.75-46.50). The 3-year OS of Haplo-cord HCT group was better than haplo-HCT group (80.5%, 95% confidence interval [CI]: 73.7-87.9 vs. 67.8% 95% CI 60.0-76.5, p = 0.013). Favorable progression-free survival (70.3%, 95% CI 62.6-78.8 vs. 57.6%, 95% CI 49.6-67.0, p = 0.012) and cumulative incidence of relapse (12.1%, 95% CI 12.0-12.2 vs. 30.3%, 95% CI 30.1-30.4, p = 0.024) were observed in haplo-cord HCT group. Grade 3-4 adverse events (AEs) within two years posttransplantation in the two groups were similar. Haplo-cord HCT patients exhibited a faster cumulative incidence of neutrophil recovery (p = 0.026) and increased T-cell reconstitution in the early period posttransplantation. Haplo-cord HCT can improve OS in AML patients without excessive AEs, which may exert additional benefits for recipients of haplo-HCT.
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Affiliation(s)
- Biqi Zhou
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Jia Chen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
| | - Tianhui Liu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Yishan Ye
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yanming Zhang
- Department of Hematology, The Affiliated Huai'an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai'an, Huai'an, China
| | - Yiyang Ding
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hong Liu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - MingQing Zhu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiao Ma
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Soochow Hopes Hematology Hospital, Suzhou, China
| | - Xiaoli Li
- Soochow Hopes Hematology Hospital, Suzhou, China
| | - Longfei Zhao
- Department of Hematology, Hygeia Suzhou Yongding Hospital, Suzhou, China
| | - Zhihong Lin
- Department of Hematology, Hygeia Suzhou Yongding Hospital, Suzhou, China
| | - He Huang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Yang Xu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
| | - Depei Wu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
- Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
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Teramoto M, Tamaki H, Kaida K, Samori M, Takahashi-Hirata S, Utsunomiya N, Katayama A, Fukunaga K, Inoue T, Yoshihara K, Ikegame K, Okada M, Yoshihara S. Pretransplantation predictors of survival in nonremission acute myeloid leukemia treated with haploidentical transplantation using steroid-based GVHD prophylaxis. Ann Hematol 2024; 103:1363-1372. [PMID: 38393656 DOI: 10.1007/s00277-024-05654-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
Haploidentical hematopoietic cell transplantation (HCT) using glucocorticoids for acute graft-versus-host disease prophylaxis (GC-haplo) may become a curative treatment option for nonremission acute myeloid leukemia (AML). This retrospective study aimed to identify pre-HCT predictors of survival in a cohort of 97 nonremission AML treated with GC-haplo in Hyogo Medical University Hospital between 2010 and 2020. Relapse and primary induction failure included in 70 (72%) and 27 (28%) patients, respectively. Sixty-one patients (63%) had undergone previous HCT. Multivariate analysis revealed that ≤ 6 months' duration between first complete remission (CR1) and first relapse (Rel1) (CR1-Rel1 interval) (hazard ratio 2.11, 95% confidence interval [CI] 1.15-3.89, P = 0.016) and serum albumin before starting the conditioning treatment of ≤ 3.5 g/dL (hazard ratio 1.80, 95%CI 1.09-2.96, P = 0.022) as risk factors for overall survival. Among three groups categorized according to serum albumin and CR1-Rel1 interval, the best 3-year overall survival was observed in patients with albumin > 3.5 g/dL and CR1-Rel1 interval > 6 months or primary induction failure (50.2%, 95%CI 28.9%-68.3%, P < 0.001), revealing that survival could be predicted using albumin and past CR duration in patients with very high-risk AML not in remission before GC-haplo.
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Affiliation(s)
- Masahiro Teramoto
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Hiroya Tamaki
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan.
| | - Katsuji Kaida
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Mami Samori
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Saki Takahashi-Hirata
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Nobuto Utsunomiya
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Atsushi Katayama
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Keiko Fukunaga
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
- Department of Hematology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Takayuki Inoue
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Kyoko Yoshihara
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Kazuhiro Ikegame
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
| | - Masaya Okada
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
- First Department of Internal Medicine, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan
| | - Satoshi Yoshihara
- Department of Hematology, Hyogo Medical University Hospital, Nishinomiya, Hyogo, Japan
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Yanada M, Yamasaki S, Kondo T, Kawata T, Harada K, Uchida N, Doki N, Yoshihara S, Katayama Y, Eto T, Tanaka M, Takada S, Kawakita T, Nishida T, Ota S, Serizawa K, Onizuka M, Kanda Y, Fukuda T, Atsuta Y, Konuma T. Allogeneic hematopoietic cell transplantation for patients with acute myeloid leukemia not in remission. Leukemia 2024; 38:513-520. [PMID: 38129514 DOI: 10.1038/s41375-023-02119-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
Allogeneic hematopoietic cell transplantation (HCT) is the last option for long-term survival for patients with chemotherapy-refractory acute myeloid leukemia (AML). By using the Japanese nationwide registry data, we analyzed 6927 adults with AML having undergone first allogeneic HCT while not in complete remission (CR) between 2001 and 2020. The 5-year overall survival (OS), relapse, and non-relapse mortality (NRM) rates were 23%, 53%, and 27%, respectively. Multivariate analysis identified several factors predictive of OS mainly through their effects on relapse (cytogenetics, percentage of blasts in the peripheral blood, and transplantation year) and NRM (age, sex, and performance status). As regards disease status, relapsed disease was associated with a higher risk of overall mortality than primary induction failure (PIF). The shorter duration of the first CR increased the risks of relapse and overall mortality for the relapsed group, and the longer time from diagnosis to transplantation did so for the PIF group. Our experience compiled over the past two decades demonstrated that >20% of patients still enjoy long-term survival with allogeneic HCT performed during non-CR and identified those less likely to benefit from allogeneic HCT. Future efforts are needed to reduce the risk of posttransplant relapse in these patients.
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Affiliation(s)
- Masamitsu Yanada
- Nagoya City University East Medical Center, Nagoya, Japan.
- Aichi Cancer Center, Nagoya, Japan.
| | | | | | - Takahito Kawata
- Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kaito Harada
- Tokai University School of Medicine, Isehara, Japan
| | | | - Noriko Doki
- Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | | | - Yuta Katayama
- Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | | | | | | | - Toshiro Kawakita
- National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Tetsuya Nishida
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | | | | | | | | | | | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
- Aichi Medical University, Nagakute, Japan
| | - Takaaki Konuma
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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4
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Nakaya Y, Koh H, Konuma T, Shimomura Y, Ishiyama K, Itonaga H, Hino M, Doki N, Nishida T, Ohigashi H, Matsuoka KI, Kanda Y, Maruyama Y, Sawa M, Eto T, Hiramoto N, Fukuda T, Atsuta Y, Nakamae H. HLA-Haploidentical Peripheral Blood Stem Cell Transplantation with Post-Transplantation Cyclophosphamide versus HLA-Matched Unrelated Donor Transplantation for Myelodysplastic Syndrome. Transplant Cell Ther 2024; 30:316.e1-316.e12. [PMID: 38108263 DOI: 10.1016/j.jtct.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/03/2023] [Accepted: 10/26/2023] [Indexed: 12/19/2023]
Abstract
Allogeneic hematopoietic cell transplantation (allo-HCT) is the sole curative therapy for myelodysplastic syndrome (MDS). In the absence of an HLA-matched sibling donor, an HLA-matched unrelated donor (MUD) is considered the leading candidate. However, in recent decades, the alternative donor pool has been extended to HLA-haploidentical donors, especially with the development of graft-versus-host disease (GVHD) prophylaxis using post-transplantation cyclophosphamide (PTCy). Comparative data for haploidentical and MUD allo-HCT in patients with MDS are scarce. We retrospectively analyzed 697 adult patients with MDS who underwent HLA-haploidentical peripheral blood stem cell transplantation (haplo-PBSCT) with PTCy (n = 136), MUD bone marrow transplantation (MUD-BMT) (n = 465), or MUD peripheral blood stem cell transplantation (MUD-PBSCT) (n = 96) as their first allo-HCT between 2014 and 2020 using Japanese registry data. Multivariable analyses demonstrated faster neutrophil engraftment (hazard ratio [HR], 2.19; 95% confidence interval [CI], 1.65 to 2.90; P < .001) and platelet engraftment (HR, 2.31; 95% CI, 1.72 to 3.10; P < 0001) in the MUD-PBSCT cohort compared with the haplo-PBSCT cohort. MUD-BMT was associated with a higher incidence of grade II-IV acute GVHD than haplo-PBSCT (HR, 1.52; 95% CI, 1.00 to 2.29; P = .048). Among patients without in vivo T cell depletion using antithymocyte globulin (ATG) (haplo-PBSCT, n = 136; MUD-BMT, n = 446; MUD-PBSCT, n = 65), MUD-PBSCT recipients experienced faster hematopoietic recovery, MUD-BMT recipients (HR, 1.54; 95% CI, 1.02 to 2.32; P = .042) or MUD-PBSCT recipients (HR, 1.83; 95% CI, 1.06 to 3.18; P = .03) had a higher incidence of grade II-IV acute GVHD, and MUD-PBSCT recipients developed chronic GVHD more frequently than haplo-PBSCT recipients (HR, 1.74; 95% CI, 1.04 to 2.89; P = .034). There were no significant differences in overall survival, disease-free survival, GVHD-free relapse-free survival, relapse, or nonrelapse mortality in the haplo-PBSCT cohort versus the MUD-BMT or MUD-PBSCT cohorts. In conclusion, despite differences in the incidences of hematopoietic engraftment and GVHD depending on graft type and ATG use in MUD transplant recipients, major transplantation outcomes were comparable between recipients of haplo-PBSCT using PTCy and recipients of MUD-BMT or MUD-PBSCT.
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Affiliation(s)
- Yosuke Nakaya
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hideo Koh
- Department of Preventive Medicine and Environmental Health, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takaaki Konuma
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Yoshimitsu Shimomura
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ken Ishiyama
- Department of Hematology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hidehiro Itonaga
- Transfusion and Cell Therapy Unit, Nagasaki University Hospital, Nagasaki, Japan
| | - Masayuki Hino
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Tetsuya Nishida
- Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Hiroyuki Ohigashi
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Yumiko Maruyama
- Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masashi Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan
| | - Tetsuya Eto
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hirohisa Nakamae
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
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Pateraki P, Latsoudis H, Papadopoulou A, Gontika I, Fragiadaki I, Mavroudi I, Bizymi N, Batsali A, Klontzas ME, Xagorari A, Michalopoulos E, Sotiropoulos D, Yannaki E, Stavropoulos-Giokas C, Papadaki HA. Perspectives for the Use of Umbilical Cord Blood in Transplantation and Beyond: Initiatives for an Advanced and Sustainable Public Banking Program in Greece. J Clin Med 2024; 13:1152. [PMID: 38398465 PMCID: PMC10889829 DOI: 10.3390/jcm13041152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/11/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
The umbilical cord blood (UCB) donated in public UCB banks is a source of hematopoietic stem cells (HSC) alternative to bone marrow for allogeneic HSC transplantation (HSCT). However, the high rejection rate of the donated units due to the strict acceptance criteria and the wide application of the haploidentical HSCT have resulted in significant limitation of the use of UCB and difficulties in the economic sustainability of the public UCB banks. There is an ongoing effort within the UCB community to optimize the use of UCB in the field of HSCT and a parallel interest in exploring the use of UCB for applications beyond HSCT i.e., in the fields of cell therapy, regenerative medicine and specialized transfusion medicine. In this report, we describe the mode of operation of the three public UCB banks in Greece as an example of an orchestrated effort to develop a viable UCB banking system by (a) prioritizing the enrichment of the national inventory by high-quality UCB units from populations with rare human leukocyte antigens (HLA), and (b) deploying novel sustainable applications of UCB beyond HSCT, through national and international collaborations. The Greek paradigm of the public UCB network may become an example for countries, particularly with high HLA heterogeneity, with public UCB banks facing sustainability difficulties and adds value to the international efforts aiming to sustainably expand the public UCB banking system.
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Affiliation(s)
- Patra Pateraki
- Law Directorate of the Health Region of Crete, Ministry of Health, Heraklion, 71500 Heraklion, Greece;
- Public Cord Blood Bank of Crete, Department of Hematology, University Hospital of Heraklion, 71500 Heraklion, Greece; (I.G.); (I.F.); (I.M.); (N.B.); (A.B.)
| | - Helen Latsoudis
- Institute of Computer Sciences, Foundation for Research and Technology–Hellas (FORTH), 70013 Heraklion, Greece;
| | - Anastasia Papadopoulou
- Gene and Cell Therapy Center, Department of Hematology-HCT Unit, George Papanikolaou Hospital, 57010 Thessaloniki, Greece;
| | - Ioanna Gontika
- Public Cord Blood Bank of Crete, Department of Hematology, University Hospital of Heraklion, 71500 Heraklion, Greece; (I.G.); (I.F.); (I.M.); (N.B.); (A.B.)
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete, 71500 Heraklion, Greece;
| | - Irene Fragiadaki
- Public Cord Blood Bank of Crete, Department of Hematology, University Hospital of Heraklion, 71500 Heraklion, Greece; (I.G.); (I.F.); (I.M.); (N.B.); (A.B.)
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete, 71500 Heraklion, Greece;
| | - Irene Mavroudi
- Public Cord Blood Bank of Crete, Department of Hematology, University Hospital of Heraklion, 71500 Heraklion, Greece; (I.G.); (I.F.); (I.M.); (N.B.); (A.B.)
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete, 71500 Heraklion, Greece;
| | - Nikoleta Bizymi
- Public Cord Blood Bank of Crete, Department of Hematology, University Hospital of Heraklion, 71500 Heraklion, Greece; (I.G.); (I.F.); (I.M.); (N.B.); (A.B.)
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete, 71500 Heraklion, Greece;
| | - Aristea Batsali
- Public Cord Blood Bank of Crete, Department of Hematology, University Hospital of Heraklion, 71500 Heraklion, Greece; (I.G.); (I.F.); (I.M.); (N.B.); (A.B.)
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete, 71500 Heraklion, Greece;
| | - Michail E. Klontzas
- Department of Radiology, School of Medicine, University of Crete, 71500 Heraklion, Greece;
- Department of Medical Imaging, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Angeliki Xagorari
- Public Cord Blood Bank, Department of Hematology, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (A.X.); (D.S.)
| | - Efstathios Michalopoulos
- Hellenic Cord Blood Bank (HCBB), Biomedical Research Foundation Academy of Athens, 11527 Athens, Greece; (E.M.); (C.S.-G.)
| | - Damianos Sotiropoulos
- Public Cord Blood Bank, Department of Hematology, George Papanikolaou Hospital, 57010 Thessaloniki, Greece; (A.X.); (D.S.)
| | - Evangelia Yannaki
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete, 71500 Heraklion, Greece;
| | - Catherine Stavropoulos-Giokas
- Hellenic Cord Blood Bank (HCBB), Biomedical Research Foundation Academy of Athens, 11527 Athens, Greece; (E.M.); (C.S.-G.)
| | - Helen A. Papadaki
- Public Cord Blood Bank of Crete, Department of Hematology, University Hospital of Heraklion, 71500 Heraklion, Greece; (I.G.); (I.F.); (I.M.); (N.B.); (A.B.)
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete, 71500 Heraklion, Greece;
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6
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Konuma T, Yamasaki S, Ishiyama K, Mizuno S, Hayashi H, Uchida N, Shimabukuro M, Tanaka M, Kuriyama T, Onizuka M, Ishiwata K, Sawa M, Tanaka T, Ohigashi H, Fujiwara SI, Matsuoka KI, Ota S, Nishida T, Kanda Y, Fukuda T, Atsuta Y, Nakasone H, Yanada M. Comparison of Allogeneic Transplant Outcomes Between Matched Sibling Donors and Alternative Donors in Patients Over 50 Years of Age with Acute Myeloid Leukemia: 8/8 Allele-Matched Unrelated Donors and Unrelated Cord Blood Provide Better Leukemia-Free Survival Compared with Matched Sibling Donors During Nonremission Status. Transplant Cell Ther 2024; 30:215.e1-215.e18. [PMID: 38081415 DOI: 10.1016/j.jtct.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/11/2023] [Accepted: 12/06/2023] [Indexed: 01/01/2024]
Abstract
Acute myeloid leukemia (AML) is the most common indication for allogeneic hematopoietic cell transplantation (HCT). The increased availability of alternative donor sources has broadened donor types for older patients without HLA-matched sibling donors (MSD). It is uncertain if an MSD should be the first option for allogeneic HCT in patients with AML over 50 years of age. The objective of this study was to compare survival and other post-transplant outcomes between MSDs, 8/8 allele-matched unrelated donors (MUDs), 7/8 allele-MUDs, unrelated cord blood (UCB), and haploidentical donors for patients with AML over 50 years of age. We conducted a retrospective study to compare outcomes in 5704 patients with AML over 50 years of age and receiving allogeneic HCT between 2013 and 2021, using either MSD, 8/8 allele-MUD, 7/8 allele-MUD, UCB, or haploidentical donors in Japan. Complete remission (CR) and nonremission at HCT were analyzed separately for all analyses. In total, 3041 patients were CR, and 2663 patients were nonremission at the time of HCT. In multivariate analysis, donor type did not determine overall survival, irrespective of disease status at HCT. Leukemia-free survival (LFS) was significantly better for 8/8 allele-MUD (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.64 to 0.93; P = .005) and UCB (HR, 0.76; 95% CI, 0.65 to 0.88; P < .001), but not for 7/8 allele-MUD (HR, 0.97; 95% CI, 0.79 to 1.19; P = .794), and haploidentical donor (HR, 0.86; 95% CI, 0.70 to 1.05; P = .146) compared to the MSD group in nonremission status. However, donor type did not determine LFS among CR status. Relapse rates were significantly lower for 8/8 allele-MUD and UCB, whereas nonrelapse mortality was higher for UCB compared to the MSD group among both CR and nonremission status. Our registry-based study demonstrated that MSDs do not lead to superior survival compared to alternative donors for patients with AML over 50 years of age. Furthermore, 8/8 allele-MUDs and UCB provide better LFS compared with MSDs during nonremission status. Therefore, MSD is not necessarily the best donor option for allogeneic HCT in this population.
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Affiliation(s)
- Takaaki Konuma
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
| | - Satoshi Yamasaki
- Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu, Japan
| | - Ken Ishiyama
- Department of Hematology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shohei Mizuno
- Division of Hematology, Department of Internal Medicine, School of Medicine, Aichi Medical University, Nagakute, Japan
| | - Hiromi Hayashi
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoyuki Uchida
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Masashi Shimabukuro
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Masatsugu Tanaka
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - Takuro Kuriyama
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Makoto Onizuka
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Kazuya Ishiwata
- Department of Hematology, Toranomon Hospital Kajigaya, Kanagawa, Japan
| | - Masashi Sawa
- Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan
| | - Takashi Tanaka
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Ohigashi
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | | | - Ken-Ichi Matsuoka
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Tetsuya Nishida
- Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University, Tochigi, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hideki Nakasone
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan; Division of Stem Cell Regulation, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Masamitsu Yanada
- Department of Hematology and Oncology, Nagoya City University East Medical Center, Nagoya, Japan
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7
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Troullioud Lucas AG, Boelens JJ, Prockop SE, Curran KJ, Bresters D, Kollen W, Versluys B, Bierings MB, Archer A, Davis E, Klein E, Kernan NA, Lindemans CA, Scaradavou A. Excellent leukemia control after second hematopoietic cell transplants with unrelated cord blood grafts for post-transplant relapse in pediatric patients. Front Oncol 2023; 13:1221782. [PMID: 37649924 PMCID: PMC10465242 DOI: 10.3389/fonc.2023.1221782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/24/2023] [Indexed: 09/01/2023] Open
Abstract
Background Patients with leukemia relapse after allogeneic hematopoietic cell transplant (HCT) have poor survival due to toxicity and disease progression. A second HCT often offers the only curative treatment. Methods We retrospectively reviewed our bi-institutional experience (MSKCC-USA; Utrecht-NL) with unrelated cord blood transplantation (CBT) for treatment of post-transplant relapse. Overall survival (OS) and event-free survival (EFS) were evaluated using the Kaplan-Meier method, treatment-related mortality (TRM) and relapse were evaluated using the competing risk method by Fine-Gray. Results Twenty-six patients age < 21 years received a second (n=24) or third (n=2) HCT with CB grafts during the period 2009-2021. Median age at first HCT (HCT1) was 11.5 (range: 0.9-17.7) years and all patients received myeloablative cytoreduction. Median time from HCT1 to relapse was 12.8 (range 5.5-189) months. At CBT, median patient age was 13.5 (range 1.4-19.1) years. Diagnoses were AML: 13; ALL: 4, MDS: 5, JMML: 2; CML: 1; mixed phenotype acute leukemia: 1. Sixteen patients (62%) were in advanced stage, either CR>2 or with active disease. Median time from HCT1 to CBT was 22.2 (range 7-63.2) months. All patients engrafted after CBT. Thirteen patients developed acute GvHD; 7 had grade III or IV. With a median survivor follow-up of 46.6 (range 17.4-155) months, 3-year OS was 69.2% (95% CI 53.6-89.5%) and 3-year EFS was 64.9% (95% CI 48.8-86.4%). Eight patients died, 3 of AML relapse and 5 due to toxicity (respiratory failure [n=4], GvHD [n=1]) at a median time of 7.7 (range 5.9-14.4) months after CBT. Cumulative incidence of TRM at 3 years was 19.2% (95% CI 4.1-34.4%). Notably, all TRM events occurred in patients transplanted up to 2015; no toxicity-related deaths were seen in the 16 patients who received CBT after 2015. Cumulative incidence of relapse was 15.9% (95% CI 1.6-30.2%) at 3 years, remarkably low for these very high-risk patients. Conclusions Survival was very encouraging following CB transplants in pediatric patients with recurrent leukemia after first HCT, and TRM has been low over the last decade. CBT needs to be strongly considered as a relatively safe salvage therapy option for post-transplant relapse.
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Affiliation(s)
- Alexandre G. Troullioud Lucas
- Department of Pediatrics, Transplantation and Cellular Therapies Service, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Stem Cell Transplantation, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
| | - Jaap Jan Boelens
- Department of Pediatrics, Transplantation and Cellular Therapies Service, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
| | - Susan E. Prockop
- Dana Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, United States
| | - Kevin J. Curran
- Department of Pediatrics, Transplantation and Cellular Therapies Service, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
| | - Dorine Bresters
- Department of Stem Cell Transplantation, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Division of Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Wouter Kollen
- Department of Stem Cell Transplantation, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Division of Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Birgitta Versluys
- Department of Stem Cell Transplantation, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Division of Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marc B. Bierings
- Department of Stem Cell Transplantation, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Division of Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Anne Archer
- Department of Pediatrics, Transplantation and Cellular Therapies Service, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Eric Davis
- Department of Pediatrics, Transplantation and Cellular Therapies Service, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Elizabeth Klein
- Department of Pediatrics, Transplantation and Cellular Therapies Service, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Nancy A. Kernan
- Department of Pediatrics, Transplantation and Cellular Therapies Service, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
| | - Caroline A. Lindemans
- Department of Stem Cell Transplantation, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Division of Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Andromachi Scaradavou
- Department of Pediatrics, Transplantation and Cellular Therapies Service, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
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8
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Effect of graft-versus-host disease on posttransplant outcomes following single cord blood transplantation in comparison to haploidentical transplantation with posttransplant cyclophosphamide for adult acute myeloid leukemia. Transplant Cell Ther 2023:S2666-6367(23)01135-1. [PMID: 36889507 DOI: 10.1016/j.jtct.2023.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/25/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND The possibility that human leukocyte antigen (HLA) mismatches could reduce relapse after alternative HLA-mismatched allogeneic hematopoietic cell transplantation (HCT) is an attractive concept for acute myeloid leukemia (AML). However, it remains unclear whether the prognostic effect of graft-versus-host disease (GVHD) on survival differs between single-unit cord blood transplantation (CBT) or haploidentical HCT using posttransplant cyclophosphamide (PTCy-haplo HCT) for AML. OBJECTIVE The objective of this retrospective study was to compare the effect of acute and chronic GVHD on posttransplant outcomes between CBT and PTCy-haplo HCT. STUDY DESIGN We retrospectively evaluated the effect of acute and chronic GVHD on posttransplant outcomes following CBT and PTCy-haplo HCT in adults with AML (n=1,981) between 2014 and 2020 using a Japanese registry database. RESULTS In the univariate analysis, the probability of overall survival was significantly greater in patients who developed grade I-II acute GVHD (P<0.001 by log-rank test) and limited chronic GVHD (P<0.001 by log-rank test) among CBT recipients, but these effects were not significant among PTCy-haplo HCT recipients. In the multivariate analysis, in which the development of GVHD was treated as a time-dependent covariate, the effect of grade I-II acute GVHD on reducing overall mortality was significant between CBT and PTCy-haplo HCT (adjusted hazard ratio [HR] for CBT: 0.73, 95% confidence interval [CI]: 0.60-0.87; adjusted HR for PTCy-haplo HCT: 1.07, 95% CI: 0.70-1.64; p for interaction=0.038). CONCLUSION Our data demonstrate that grade I-II acute GVHD was associated with a significant improvement in overall mortality in adults with AML receiving CBT but not PTCy-haplo HCT.
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9
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Matsuda K, Konuma T, Yanada M. Cord blood versus haploidentical transplantations for non-remission acute myeloid leukaemia: Authors' reply. Br J Haematol 2023; 200:678-679. [PMID: 36564809 DOI: 10.1111/bjh.18626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Kensuke Matsuda
- Department of Haematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Haematology and Oncology, JR Tokyo General Hospital, Tokyo, Japan
| | - Takaaki Konuma
- Department of Haematology and Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Masamitsu Yanada
- Department of Haematology and Cell Therapy, Aichi Cancer Centre, Nagoya, Japan
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10
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Scaradavou A, Boelens JJ. Lower probability of relapse after myeloablative cord blood transplantation for patients with refractory AML. Br J Haematol 2023; 200:676-677. [PMID: 36544239 DOI: 10.1111/bjh.18622] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Andromachi Scaradavou
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jaap Jan Boelens
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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11
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Castagna L, Patti K, Mulè A. Don't forget cord blood in non‐remission
acute myeloid leukaemia
! Br J Haematol 2022; 201:11-12. [PMID: 36507800 DOI: 10.1111/bjh.18604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
Transplantation from haploidentical donors is widely used, with progressive reduction of cord blood (CB) as alternative donor. The paper by Matsuda and colleagues, the largest analysing the outcome in non-remission acute myeloid leukaemia (AML) transplanted with haploidentical donor or CB, suggests that CB is still a viable option when considering allogeneic transplantation for advanced AML. Commentary on: Matsuda et al. Comparison of transplant outcomes between haploidentical transplantation and single cord blood transplantation in non-remission acute myeloid leukaemia: A nationwide retrospective study. Br J Haematol. 2023;201:106-113.
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Affiliation(s)
- Luca Castagna
- BMT Unit Ospedale Villa Sofia Cervello Palermo Italy
| | - Katia Patti
- Onco‐Hematology Unit Ospedale Villa Sofia Cervello Palermo Italy
| | - Antonino Mulè
- Onco‐Hematology Unit Ospedale Villa Sofia Cervello Palermo Italy
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