COMPARISON OF OUTCOMES AFTER SINGLE OR DOUBLE UNIT UCBT FOLLOWING RIC IN ADULTS WITH ACUTE LEUKEMIA: A REPORT FROM EUROCORD, THE ALWP & THE CORD BLOOD COMMITTEE OF THE CTIWP OF THE EBMT
(Abstract release date: 05/19/16)
EHA Library. Baron F. 06/12/16; 135315; S821
Dr. Frederic Baron
Contributions
Contributions
Abstract
Abstract: S821
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:45 - 09:00
Location: Hall C15
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. In patients given CBT following myeloablative conditioning, previous studies have demonstrated that, although double CBT extended the use of CBT for patients lacking a single unit with adequate cells (>2.5 x 107 total nucleated cells (TNC)/kg), it failed to improve engraftment and outcomes.
Aims
Here we investigated whether these observations remained true in the setting of reduced-intensity conditioning (RIC) CBT.
Methods
Inclusion criteria included adult (> 18 yrs) 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 x 10E7/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 comparison to patients transplanted with a single CB, double CB recipients had a shorter follow-up (34 vs 54 months, P=0.0005), were more frequently male (56 vs 41%, P=0.002), received more frequently a conditioning combining TBI, cyclophosphamide and Flu (TCF regimen, 83 vs 66%, P<0.001), and received less frequently ATG (16% vs 37%, P<0.001). In univariate analysis, in comparison to patients transplanted with a single CB, double CB recipients had a suggestion for a higher incidence of grade II-IV acute GVHD (36 vs 28%, P=0.08) but a similar incidence of neutrophil engraftment (83 vs 77%, P=0.3). Further, at 3-year, in comparison to single CB recipients, double CB recipients had a similar incidence of chronic GVHD (36 vs 28%, P= 0.17), a similar incidence of relapse (32 vs 35%, P=0.4), a similar incidence of nonrelapse mortality (22 vs 29%, P=0.17) but a better OS (51 vs 41%, P=0.03) and LFS (46 vs 36%, P=0.06) (Figure 1). In multivariate analyses OS (HR=0.8, 95% CI 0.7-1.1, P=0.20) and LFS (HR=0.8, 95% CI 0.6-1.1, P=0.17) were no longer significantly better in double CB than in single CB recipients, although there remained a trend in that direction.Figure 1. Unadjusted CBT outcomes in patients transplanted following RIC with a single or a double CB.
Conclusion
These data suggest that LFS and OS are not different for double than single UCB with an adequate TNC dose in the RIC setting. These observations should serve as basis for future prospective randomized studies.
Session topic: Stem cell transplantation - Clinical 2
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:45 - 09:00
Location: Hall C15
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. In patients given CBT following myeloablative conditioning, previous studies have demonstrated that, although double CBT extended the use of CBT for patients lacking a single unit with adequate cells (>2.5 x 107 total nucleated cells (TNC)/kg), it failed to improve engraftment and outcomes.
Aims
Here we investigated whether these observations remained true in the setting of reduced-intensity conditioning (RIC) CBT.
Methods
Inclusion criteria included adult (> 18 yrs) 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 x 10E7/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 comparison to patients transplanted with a single CB, double CB recipients had a shorter follow-up (34 vs 54 months, P=0.0005), were more frequently male (56 vs 41%, P=0.002), received more frequently a conditioning combining TBI, cyclophosphamide and Flu (TCF regimen, 83 vs 66%, P<0.001), and received less frequently ATG (16% vs 37%, P<0.001). In univariate analysis, in comparison to patients transplanted with a single CB, double CB recipients had a suggestion for a higher incidence of grade II-IV acute GVHD (36 vs 28%, P=0.08) but a similar incidence of neutrophil engraftment (83 vs 77%, P=0.3). Further, at 3-year, in comparison to single CB recipients, double CB recipients had a similar incidence of chronic GVHD (36 vs 28%, P= 0.17), a similar incidence of relapse (32 vs 35%, P=0.4), a similar incidence of nonrelapse mortality (22 vs 29%, P=0.17) but a better OS (51 vs 41%, P=0.03) and LFS (46 vs 36%, P=0.06) (Figure 1). In multivariate analyses OS (HR=0.8, 95% CI 0.7-1.1, P=0.20) and LFS (HR=0.8, 95% CI 0.6-1.1, P=0.17) were no longer significantly better in double CB than in single CB recipients, although there remained a trend in that direction.Figure 1. Unadjusted CBT outcomes in patients transplanted following RIC with a single or a double CB.
Conclusion
These data suggest that LFS and OS are not different for double than single UCB with an adequate TNC dose in the RIC setting. These observations should serve as basis for future prospective randomized studies.
Session topic: Stem cell transplantation - Clinical 2
Abstract: S821
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:45 - 09:00
Location: Hall C15
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. In patients given CBT following myeloablative conditioning, previous studies have demonstrated that, although double CBT extended the use of CBT for patients lacking a single unit with adequate cells (>2.5 x 107 total nucleated cells (TNC)/kg), it failed to improve engraftment and outcomes.
Aims
Here we investigated whether these observations remained true in the setting of reduced-intensity conditioning (RIC) CBT.
Methods
Inclusion criteria included adult (> 18 yrs) 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 x 10E7/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 comparison to patients transplanted with a single CB, double CB recipients had a shorter follow-up (34 vs 54 months, P=0.0005), were more frequently male (56 vs 41%, P=0.002), received more frequently a conditioning combining TBI, cyclophosphamide and Flu (TCF regimen, 83 vs 66%, P<0.001), and received less frequently ATG (16% vs 37%, P<0.001). In univariate analysis, in comparison to patients transplanted with a single CB, double CB recipients had a suggestion for a higher incidence of grade II-IV acute GVHD (36 vs 28%, P=0.08) but a similar incidence of neutrophil engraftment (83 vs 77%, P=0.3). Further, at 3-year, in comparison to single CB recipients, double CB recipients had a similar incidence of chronic GVHD (36 vs 28%, P= 0.17), a similar incidence of relapse (32 vs 35%, P=0.4), a similar incidence of nonrelapse mortality (22 vs 29%, P=0.17) but a better OS (51 vs 41%, P=0.03) and LFS (46 vs 36%, P=0.06) (Figure 1). In multivariate analyses OS (HR=0.8, 95% CI 0.7-1.1, P=0.20) and LFS (HR=0.8, 95% CI 0.6-1.1, P=0.17) were no longer significantly better in double CB than in single CB recipients, although there remained a trend in that direction.Figure 1. Unadjusted CBT outcomes in patients transplanted following RIC with a single or a double CB.
Conclusion
These data suggest that LFS and OS are not different for double than single UCB with an adequate TNC dose in the RIC setting. These observations should serve as basis for future prospective randomized studies.
Session topic: Stem cell transplantation - Clinical 2
Type: Oral Presentation
Presentation during EHA21: On Sunday, June 12, 2016 from 08:45 - 09:00
Location: Hall C15
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. In patients given CBT following myeloablative conditioning, previous studies have demonstrated that, although double CBT extended the use of CBT for patients lacking a single unit with adequate cells (>2.5 x 107 total nucleated cells (TNC)/kg), it failed to improve engraftment and outcomes.
Aims
Here we investigated whether these observations remained true in the setting of reduced-intensity conditioning (RIC) CBT.
Methods
Inclusion criteria included adult (> 18 yrs) 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 x 10E7/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 comparison to patients transplanted with a single CB, double CB recipients had a shorter follow-up (34 vs 54 months, P=0.0005), were more frequently male (56 vs 41%, P=0.002), received more frequently a conditioning combining TBI, cyclophosphamide and Flu (TCF regimen, 83 vs 66%, P<0.001), and received less frequently ATG (16% vs 37%, P<0.001). In univariate analysis, in comparison to patients transplanted with a single CB, double CB recipients had a suggestion for a higher incidence of grade II-IV acute GVHD (36 vs 28%, P=0.08) but a similar incidence of neutrophil engraftment (83 vs 77%, P=0.3). Further, at 3-year, in comparison to single CB recipients, double CB recipients had a similar incidence of chronic GVHD (36 vs 28%, P= 0.17), a similar incidence of relapse (32 vs 35%, P=0.4), a similar incidence of nonrelapse mortality (22 vs 29%, P=0.17) but a better OS (51 vs 41%, P=0.03) and LFS (46 vs 36%, P=0.06) (Figure 1). In multivariate analyses OS (HR=0.8, 95% CI 0.7-1.1, P=0.20) and LFS (HR=0.8, 95% CI 0.6-1.1, P=0.17) were no longer significantly better in double CB than in single CB recipients, although there remained a trend in that direction.Figure 1. Unadjusted CBT outcomes in patients transplanted following RIC with a single or a double CB.
Conclusion
These data suggest that LFS and OS are not different for double than single UCB with an adequate TNC dose in the RIC setting. These observations should serve as basis for future prospective randomized studies.
Session topic: Stem cell transplantation - Clinical 2
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