6533b851fe1ef96bd12aa1ee

RESEARCH PRODUCT

Prospective Randomized Study Comparing Myeloablative Unrelated Umbilical Cord Blood Transplantation versus HLA-Haploidentical Related Stem Cell Transplantation for Adults with Hematologic Malignancies

José Luis PiñanaAntonia SampolMiguel A. SanzMiguel A. SanzGuillermo SanzGuillermo SanzDavid ValcárcelCarlos SolanoManuel GuerreiroRocío ParodyGuillermo OrtíChristelle FerraIgnacio LorenzoJuan MontoroAitana Balaguer-rosellóCarlos CarreteroJaime SanzJaime SanzJuan C. Hernández-boludaPau Montesinos

subject

Adultmedicine.medical_specialtyendocrine systemHematologic malignancyTransplantation ConditioningHaploidentical transplantationGraft vs Host DiseaseContext (language use)ThioTEPAGastroenterologyMAC Regimen03 medical and health sciences0302 clinical medicineInternal medicinemedicineHumansCumulative incidenceProspective StudiesTransplantationAllogeneic stem cell transplantation clinical trial Alternative donor transplantation Haploidentical transplantation Hematologic malignancy Umbilical cord blood transplantationUmbilical cord blood transplantationbusiness.industryHematopoietic Stem Cell TransplantationHematologyAlternative donor transplantationFludarabineTransplantationRegimenAllogeneic stem cell transplantation clinical trialsurgical procedures operative030220 oncology & carcinogenesisHematologic NeoplasmsCord Blood Stem Cell TransplantationNeoplasm Recurrence LocalbusinessBusulfan030215 immunologymedicine.drug

description

In this prospective randomized study, we compared the outcomes of single-unit umbilical cord blood transplantation (UCBT) and unmanipulated haploidentical stem cell transplantation (haplo-SCT) with post-transplantation cyclophosphamide (PTCy) in adults with hematologic malignancies. All patients received a myeloablative conditioning (MAC) regimen consisting of thiotepa, busulfan, and fludarabine, with antithymocyte globulin (ATG) added for UCBT recipients. Nineteen patients were randomized to UCBT and the other 26 to haplo-HSCT. Four patients (15%) allocated to the haplo-HSCT arm lacked a suitable donor and were crossed over to the UCBT arm. Finally, 23 underwent UCBT and 22 underwent haplo-HSCT. The cumulative incidence of neutrophil recovery was 87% at a median of 19 days (range, 13 to 24 days) in the UCBT arm versus 100% at a median of 17 days (range, 13 to 25 days) in the haplo-SCT arm (P=.04). Platelet recovery was 70% at a median of 40 days (range, 18 to 129 days) in the UCBT arm versus 86% at a median of 24 days (range, 12 to 127 days) in the haplo-HCT arm (P=.02). Rates of acute graft-versus-host disease (GVHD) grade II-IV or grade overall chronic GVHD, and extensive chronic GVHD in the UCBT and Haplo-SCT arms were 43% versus 36% (P=.8), 9% versus 9% (P=1), 66% versus 43% (P=.04), and 41% versus 23% (P=.2), respectively. Two-year nonrelapse mortality and relapse in the 2 arms were 52% versus 23% (P=.06) and 17% versus 23% (P=.5), respectively. Two-year disease-free survival, overall survival, and GVHD/relapse-free survival in the 2 arms were 30% versus 54% (P=.2), 35% versus 59% (P=.1), and 17% versus 40% (P=.04), respectively. Our data show that in the context of an MAC regimen, haplo-SCT with PTCy provides improved outcomes compared with ATG-containing single-unit UCBT.

yearjournalcountryeditionlanguage
2020-02-01
https://fundanet.igtp.cat/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=1228