Outcomes after Umbilical Cord Blood Transplantation for Myelodysplastic Syndromes.

Gerds AT; Woo Ahn K; Hu ZH; Abdel-Azim H; Akpek G; Aljurf M; Ballen KK; Beitinjaneh A; Bacher U; Cahn JY; Chhabra S; Cutler C; Daly A; DeFilipp Z; Gale RP; Gergis U; Grunwald MR; Hale GA; Hamilton BK; Jagasia M; Kamble RT; Kindwall-Keller T; Nishihori T; Olsson RF; Ramanathan M; Saad AA; Solh M; Ustun C; Valcárcel D; Warlick E; Wirk BM; Kalaycio M; Alyea E; Popat U; Sobecks R; Saber W

doi:10.1016/j.bbmt.2017.03.014

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Journal article

Outcomes after Umbilical Cord Blood Transplantation for Myelodysplastic Syndromes.

Gerds AT Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: gerdsa@ccf.org.
Woo Ahn K 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.
Hu ZH Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Abdel-Azim H Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California.
Akpek G Stem Cell Transplantation and Cell Therapy, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
Aljurf M Department of Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Ballen KK Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Beitinjaneh A Division of Hematology and Oncology, University of Miami, Miami, Florida.
Bacher U Department of Hematology, Inselspital Bern, Bern, Switzerland; Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany.
Cahn JY Department of Hematology, University Hospital, Grenoble, France.
Chhabra S Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Cutler C Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Daly A Tom Baker Cancer Center, Calgary, Alberta, Canada.
DeFilipp Z Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Gale RP Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom.
Gergis U Hematolgic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.
Grunwald MR Levine Cancer Institute, Charlotte, North Carolina.
Hale GA Department of Hematology/Oncology, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
Hamilton BK Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio.
Jagasia M Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
Kamble RT Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas.
Kindwall-Keller T Division of Hematology/Oncology, University of Virginia Health System, Charlottesville, Virginia.
Nishihori T Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
Olsson RF Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden.
Ramanathan M Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, Massachusetts.
Saad AA Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Solh M The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia.
Ustun C Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
Valcárcel D Department of Hematology, Hospital Vall d'Hebron, Barcelona, Spain.
Warlick E Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
Wirk BM Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, Washington.
Kalaycio M Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
Alyea E Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Popat U M.D. Anderson Cancer Center, Houston, Texas.
Sobecks R Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
Saber W Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.

2017-03-15

Published in:

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. - 2017

Blood and marrow transplantation

Umbilical cord transplantation

Cord Blood Stem Cell Transplantation

English 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.

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