Allogeneic hematopoietic cell transplantation with cord blood versus mismatched unrelated donor with post-transplant cyclophosphamide in acute myeloid leukemia

Bhagirathbhai Dholaria*, Myriam Labopin, Jaime Sanz, Annalisa Ruggeri, Jan Cornelissen, Hélène Labussière-Wallet, Didier Blaise, Edouard Forcade, Patrice Chevallier, Anna Grassi, Ludmila Zubarovskaya, Jürgen Kuball, Patrice Ceballos, Fabio Ciceri, Frederic Baron, Bipin N. Savani, Arnon Nagler, Mohamad Mohty

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background: Allogeneic hematopoietic cell transplantation (allo-HCT) using a mismatched unrelated donor (MMUD) and cord blood transplantation (CBT) are valid alternatives for patients without a fully human leukocyte antigen (HLA)-matched donor. Here, we compared the allo-HCT outcomes of CBT versus single-allele-mismatched MMUD allo-HCT with post-transplant cyclophosphamide (PTCy) in acute myeloid leukemia. Methods: Patients who underwent a first CBT without PTCy (N = 902) or allo-HCT from a (HLA 9/10) MMUD with PTCy (N = 280) were included in the study. A multivariate regression analysis was performed for the whole population. A matched-pair analysis was carried out by propensity score-based 1:1 matching of patients (177 pairs) with known cytogenetic risk. Results: The incidence of grade II–IV and grade III–IV acute graft-versus-host disease (GVHD) at 6 months was 36% versus 32% (p = 0.07) and 15% versus 11% (p = 0.16) for CBT and MMUD cohorts, respectively. CBT was associated with a higher incidence of graft failure (11% vs. 4%, p < 0.01) and higher 2-year non-relapse mortality (NRM) (30% vs. 16%, p < 0.01) compared to MMUD. In the multivariate analysis, CBT was associated with a higher risk of, NRM (HR = 2.09, 95% CI 1.46–2.99, p < 0.0001), and relapse (HR = 1.35, 95% CI 1–1.83, p = 0.05), which resulted in worse leukemia-free survival (LFS) (HR = 1.68, 95% CI 1.34–2.12, p < 0.0001), overall survival (OS) (HR = 1.7, 95% CI 1.33–2.17, p < 0.0001), and GVHD-free, relapse-free survival (GRFS) (HR = 1.49, 95% CI 1.21–1.83, p < 0.0001) compared to MMUD. The risk of grade II–IV acute GVHD (p = 0.052) and chronic GVHD (p = 0.69) did not differ significantly between the cohorts. These results were confirmed in a matched-pair analysis. Conclusions: CBT was associated with lower LFS, OS, and GRFS due to higher NRM, compared to MMUD allo-HCT with PTCy. In the absence of a fully matched donor, 9/10 MMUD with PTCy may be preferred over CBT.

Original languageEnglish
Article number76
JournalJournal of Hematology and Oncology
Volume14
Issue number1
DOIs
StatePublished - Dec 2021
Externally publishedYes

Funding

FundersFunder number
EBMT

    Keywords

    • Acute leukemia
    • Acute myeloid leukemia
    • Allogeneic hematopoietic cell transplantation
    • Bone marrow
    • Cord blood transplantation
    • Cord blood unit
    • Disease relapse
    • Graft-versus-host disease
    • Human leukocyte antigen
    • Mismatched donor
    • Peripheral blood stem cell
    • Post-transplant cyclophosphamide
    • Toxicity

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