Good Outcome Reported With Unrelated-Donor Cord Blood Transplantation in Patients With Minimal Residual Disease
Survival with hematopoietic cell transplantation (HCT) from unrelated cord-blood donors was at least as good as that with HLA-matched unrelated donors and better than that with HLA-mismatched unrelated donors in patients with acute leukemia or myelodysplastic syndrome who had pretransplantation minimal residual disease. These findings from a single-center retrospective analysis were reported by Milano et al in The New England Journal of Medicine.
The study included all 582 patients with acute myeloid or lymphoid leukemia or myelodysplastic syndrome who received a first allogeneic HCT from an unrelated donor at Fred Hutchinson Cancer Research Center between January 2006 and December 2014 with a stem cell source of cord blood (n = 140), bone marrow, or peripheral blood; 344 patients had an HLA-matched unrelated donor, and 98 had an HLA-mismatched unrelated donor.
Survival and Relapse
Pretransplantation minimal residual disease was present in 33% of the cord-blood group, 31% of the HLA-matched group, and 39% of the HLA-mismatched group. Among patients with minimal residual disease, the risk of death was significantly higher in the HLA-mismatched group (hazard ratio [HR] = 2.92, P = 0.001) and nonsignificantly higher in the HLA-matched group (HR = 1.69, P = .08) compared with the cord-blood group. Among patients without minimal residual disease, hazard ratios were 1.36 (P = .30) in the HLA-mismatched group and 0.78 (P = .33) in the HLA-matched group vs the cord-blood group.
Among patients with minimal residual disease, the risk of relapse was significantly higher in the HLA-mismatched group (HR = 3.01, P = .02) and the HLA-matched group (HR = 2.92, P = .007). Among patients without minimal residual disease, the risk was nonsignificantly increased in the HLA-mismatched group (HR = 1.28, P = .60) and the HLA-matched group (HR = 1.30, P = .46).
The investigators concluded: “Our data suggest that among patients with pretransplantation minimal residual disease, the probability of overall survival after receipt of a transplant from a cord-blood donor was at least as favorable as that after receipt of a transplant from an HLA-matched unrelated donor and was significantly higher than the probability after receipt of a transplant from an HLA-mismatched unrelated donor. Furthermore, the probability of relapse was lower in the cord-blood group than in either of the other groups.”
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