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Double cord blood transplant associated with better outcomes in acute leukemia
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52nd ASH Annual Meeting
ORLANDO — Adults with leukemia in remission who underwent double unrelated cord blood transplantation had superior disease-free survival and lower rates of relapse, according to a retrospective study performed in Europe.
Previous results from the University of Minnesota showed that patients who received double unrelated cord blood transplantation have a higher incidence of acute graft-versus-host disease, but lower incidence of relapse and no difference in leukemia-free survival compared with single-unit cord blood transplantation recipients. Vanderson Rocha, MD, PhD, scientific director of Eurocord Registry at Hopital Saint Louis in Paris, said these results uphold those earlier findings, and researchers confirmed a reduction in relapse rate for leukemia.
“We have confirmed the results of the Minnesota group. We have higher incidence of graft-versus-host disease, but this higher incidence is mainly grade 2,” he said. “There was a trend for lower relapse rate of leukemia in those patients receiving double transplantation.”
Rocha discussed the results Sunday at the 52nd ASH Annual Meeting.
To confirm the findings from Minnesota, Schmidt et al retrospectively analyzed outcomes after dUCBT in 230 adults with acute myeloid or lymphoblastic leukemia in remission and outcomes for 377 patients who underwent sUCBT.
Compared with patients in the sUCBT group, patients in the dUCBT group were heavier (68kg vs. 65kg), older (37 years vs. 35 years), had lower frequency of poor cytogenetics (32% vs. 36%), were transplanted more recently, were given RIC more frequently (53% vs. 30%) and received less ATG/ALG (29% vs. 70%). The number of HLA disparities was not statistically different between the two groups.
Researchers analyzed patients transplanted in first complete remission and in patients transplanted in second or third complete remission. The differences between dUCBT and sUCBT remained the same in both analyses.
Median follow-up for patients in first complete remission was 17 months for 114 dUCBT recipients and 19 months for 203 sUCBT recipients. Cumulative incidence of neutrophil recovery was 78% after dUCBT and 82% after sUCBT (P=.11) on unadjusted univariate analysis. Acute GVHD was 45% in the dUCBT recipients vs. 27% in the sUCBT group.
Estimated 3-year leukemia-free survival favored the dUCBT group, 53% vs. 39% (P=.09). At 3 years, cumulative incidence of non-relapse mortality favored dUCBT recipients 32% vs. 36% (P=.89), as did cumulative incidence of relapse, 15% vs. 25%.
After adjusting for the differences between the two groups, multivariate analysis showed that dUCBT recipients had an increased risk for grade II-IV acute GVHD (HR=1.23) and decreased risk for relapse incidence (HR=0.74). There was no statistical difference between the groups for neutrophil and platelet recovery, non-relapse mortality and chronic GVHD.
Leukemia-free survival improved for dUCBT recipients compared with sUCBT recipients on multivariate analysis. (HR=0.67). – by Jason Harris
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It would be very interesting if the improved disease-free survival translated into improved overall survival in the double-cord group — we need longer follow-up to find out whether that’s the case. I would reserve judgment until the Minnesota study, which is one vs. two cords, and the prospective Eurocord study are completed. This is challenging because we feel there is an issue when using single cords with larger patients. If you have an adequate number of cells, the question is: Are more cells better and as a consequence, are two cords better than one? We’re still not sure, but it looks promising.
- Armand Keating, MD
Director of the Division
of Hematology and Epstein Chair in Cell Therapy and Transplantation,
University of Toronto
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