Early Lymphocyte Recovery and Outcomes after Umbilical Cord Blood Transplantation (UCBT) for Hematologic Malignancies

Michael J. Burke; Rachel Isaksson Vogel; Sanyukta K. Janardan; Claudio Brunstein; Angela R. Smith; Jeffrey S. Miller; Daniel Weisdorf; John E. Wagner; Michael R. Verneris

doi:10.1016/j.bbmt.2010.08.022

Early Lymphocyte Recovery and Outcomes after Umbilical Cord Blood Transplantation (UCBT) for Hematologic Malignancies

Michael J. Burke, Rachel Isaksson Vogel, Sanyukta K. Janardan, Claudio Brunstein, Angela R. Smith, Jeffrey S. Miller, Daniel Weisdorf, John E. Wagner, Michael R. Verneris

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Abstract

Rapid lymphocyte recovery after bone marrow or peripheral blood transplantation is associated with improved survival. However, the impact of early lymphocyte recovery has not been examined after umbilical cord blood transplant (UCBT). We evaluated lymphocyte recovery in 360 consecutive patients with hematologic malignancy that underwent UCBT between 2001 and 2007. Uniform myeloablative (MA), reduced intensity conditioning (RIC) and graft-versus-host disease prophylaxis regimens were used. In multivariate analysis, an absolute leukocyte count (ALC) >200 × 10⁶/L at day 30 (n = 73) after MA conditioning was associated with superior 2-year overall survival (OS) (73% versus 61%; P = .02) (relative risk [RR]: 2.29; 95% confidence interval [CI]: 1.15-4.56), progression-free survival (PFS) (68% versus 54%; P = .05) (RR: 1.96; 95% CI: 0.99-3.86) and less transplant-related mortality (8% versus 28%, P < .01) (RR: 4.38; 95% CI: 1.65-11.60) compared to ≤200 × 10⁶/L (n = 43). Similarly, an ALC >200 × 10⁶/L at day 42 (n = 105) after RIC was associated with superior 2-year OS (59% versus 41%, P < .01) (RR: 2.10; 95% CI: 1.3-3.41) and PFS (46% versus 36%, P = .05) (RR: 1.58; 95% CI: 1.01-2.49) compared to ≤200 × 10⁶/L (n = 55). There was no significant relationship between ALC and relapse. Rapid lymphocyte recovery early after UCBT predicts better survival in patients with hematologic malignancies.

Original language	English (US)
Pages (from-to)	831-840
Number of pages	10
Journal	Biology of Blood and Marrow Transplantation
Volume	17
Issue number	6
DOIs	https://doi.org/10.1016/j.bbmt.2010.08.022
State	Published - Jun 2011

Bibliographical note

Funding Information:
Financial disclosure: This work was supported in part by grants from the National Institutes of Health NCI P01-CA65493 (J.E.W., B.R.B., J.S.M., and M.R.V.), American Cancer Society RSG-08-181-LIB (M.R.V.), Leukemia Research Fund (M.R.V.), and Children’s Cancer Research Fund (M.R.V., M.J.B., and J.E.W.).

Keywords

ALL
AML
Absolute lymphocyte count
Allogeneic hematopoietic cell transplantation
Reduced-intensity conditioning
Umbilical cord blood

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@article{ea11694a418c4f2da67b409ce0ef44db,

title = "Early Lymphocyte Recovery and Outcomes after Umbilical Cord Blood Transplantation (UCBT) for Hematologic Malignancies",

abstract = "Rapid lymphocyte recovery after bone marrow or peripheral blood transplantation is associated with improved survival. However, the impact of early lymphocyte recovery has not been examined after umbilical cord blood transplant (UCBT). We evaluated lymphocyte recovery in 360 consecutive patients with hematologic malignancy that underwent UCBT between 2001 and 2007. Uniform myeloablative (MA), reduced intensity conditioning (RIC) and graft-versus-host disease prophylaxis regimens were used. In multivariate analysis, an absolute leukocyte count (ALC) >200 × 106/L at day 30 (n = 73) after MA conditioning was associated with superior 2-year overall survival (OS) (73% versus 61%; P = .02) (relative risk [RR]: 2.29; 95% confidence interval [CI]: 1.15-4.56), progression-free survival (PFS) (68% versus 54%; P = .05) (RR: 1.96; 95% CI: 0.99-3.86) and less transplant-related mortality (8% versus 28%, P < .01) (RR: 4.38; 95% CI: 1.65-11.60) compared to ≤200 × 106/L (n = 43). Similarly, an ALC >200 × 106/L at day 42 (n = 105) after RIC was associated with superior 2-year OS (59% versus 41%, P < .01) (RR: 2.10; 95% CI: 1.3-3.41) and PFS (46% versus 36%, P = .05) (RR: 1.58; 95% CI: 1.01-2.49) compared to ≤200 × 106/L (n = 55). There was no significant relationship between ALC and relapse. Rapid lymphocyte recovery early after UCBT predicts better survival in patients with hematologic malignancies.",

keywords = "ALL, AML, Absolute lymphocyte count, Allogeneic hematopoietic cell transplantation, Reduced-intensity conditioning, Umbilical cord blood",

author = "Burke, {Michael J.} and Vogel, {Rachel Isaksson} and Janardan, {Sanyukta K.} and Claudio Brunstein and Smith, {Angela R.} and Miller, {Jeffrey S.} and Daniel Weisdorf and Wagner, {John E.} and Verneris, {Michael R.}",

note = "Funding Information: Financial disclosure: This work was supported in part by grants from the National Institutes of Health NCI P01-CA65493 (J.E.W., B.R.B., J.S.M., and M.R.V.), American Cancer Society RSG-08-181-LIB (M.R.V.), Leukemia Research Fund (M.R.V.), and Children{\textquoteright}s Cancer Research Fund (M.R.V., M.J.B., and J.E.W.). ",

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doi = "10.1016/j.bbmt.2010.08.022",

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AU - Burke, Michael J.

AU - Vogel, Rachel Isaksson

AU - Janardan, Sanyukta K.

AU - Brunstein, Claudio

AU - Smith, Angela R.

AU - Miller, Jeffrey S.

AU - Weisdorf, Daniel

AU - Wagner, John E.

AU - Verneris, Michael R.

N1 - Funding Information: Financial disclosure: This work was supported in part by grants from the National Institutes of Health NCI P01-CA65493 (J.E.W., B.R.B., J.S.M., and M.R.V.), American Cancer Society RSG-08-181-LIB (M.R.V.), Leukemia Research Fund (M.R.V.), and Children’s Cancer Research Fund (M.R.V., M.J.B., and J.E.W.).

PY - 2011/6

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N2 - Rapid lymphocyte recovery after bone marrow or peripheral blood transplantation is associated with improved survival. However, the impact of early lymphocyte recovery has not been examined after umbilical cord blood transplant (UCBT). We evaluated lymphocyte recovery in 360 consecutive patients with hematologic malignancy that underwent UCBT between 2001 and 2007. Uniform myeloablative (MA), reduced intensity conditioning (RIC) and graft-versus-host disease prophylaxis regimens were used. In multivariate analysis, an absolute leukocyte count (ALC) >200 × 106/L at day 30 (n = 73) after MA conditioning was associated with superior 2-year overall survival (OS) (73% versus 61%; P = .02) (relative risk [RR]: 2.29; 95% confidence interval [CI]: 1.15-4.56), progression-free survival (PFS) (68% versus 54%; P = .05) (RR: 1.96; 95% CI: 0.99-3.86) and less transplant-related mortality (8% versus 28%, P < .01) (RR: 4.38; 95% CI: 1.65-11.60) compared to ≤200 × 106/L (n = 43). Similarly, an ALC >200 × 106/L at day 42 (n = 105) after RIC was associated with superior 2-year OS (59% versus 41%, P < .01) (RR: 2.10; 95% CI: 1.3-3.41) and PFS (46% versus 36%, P = .05) (RR: 1.58; 95% CI: 1.01-2.49) compared to ≤200 × 106/L (n = 55). There was no significant relationship between ALC and relapse. Rapid lymphocyte recovery early after UCBT predicts better survival in patients with hematologic malignancies.

AB - Rapid lymphocyte recovery after bone marrow or peripheral blood transplantation is associated with improved survival. However, the impact of early lymphocyte recovery has not been examined after umbilical cord blood transplant (UCBT). We evaluated lymphocyte recovery in 360 consecutive patients with hematologic malignancy that underwent UCBT between 2001 and 2007. Uniform myeloablative (MA), reduced intensity conditioning (RIC) and graft-versus-host disease prophylaxis regimens were used. In multivariate analysis, an absolute leukocyte count (ALC) >200 × 106/L at day 30 (n = 73) after MA conditioning was associated with superior 2-year overall survival (OS) (73% versus 61%; P = .02) (relative risk [RR]: 2.29; 95% confidence interval [CI]: 1.15-4.56), progression-free survival (PFS) (68% versus 54%; P = .05) (RR: 1.96; 95% CI: 0.99-3.86) and less transplant-related mortality (8% versus 28%, P < .01) (RR: 4.38; 95% CI: 1.65-11.60) compared to ≤200 × 106/L (n = 43). Similarly, an ALC >200 × 106/L at day 42 (n = 105) after RIC was associated with superior 2-year OS (59% versus 41%, P < .01) (RR: 2.10; 95% CI: 1.3-3.41) and PFS (46% versus 36%, P = .05) (RR: 1.58; 95% CI: 1.01-2.49) compared to ≤200 × 106/L (n = 55). There was no significant relationship between ALC and relapse. Rapid lymphocyte recovery early after UCBT predicts better survival in patients with hematologic malignancies.

KW - ALL

KW - AML

KW - Absolute lymphocyte count

KW - Allogeneic hematopoietic cell transplantation

KW - Reduced-intensity conditioning

KW - Umbilical cord blood

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Early Lymphocyte Recovery and Outcomes after Umbilical Cord Blood Transplantation (UCBT) for Hematologic Malignancies

Abstract

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Keywords

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