TY - JOUR
T1 - Outcomes after Umbilical Cord Blood Transplantation for Myelodysplastic Syndromes
AU - Gerds, Aaron T.
AU - Woo Ahn, Kwang
AU - Hu, Zhen Huan
AU - Abdel-Azim, Hisham
AU - Akpek, Gorgun
AU - Aljurf, Mahmoud
AU - Ballen, Karen K.
AU - Beitinjaneh, Amer
AU - Bacher, Ulrike
AU - Cahn, Jean Yves
AU - Chhabra, Saurabh
AU - Cutler, Corey
AU - Daly, Andrew
AU - DeFilipp, Zachariah
AU - Gale, Robert Peter
AU - Gergis, Usama
AU - Grunwald, Michael R.
AU - Hale, Gregory A.
AU - Hamilton, Betty Ky
AU - Jagasia, Madan
AU - Kamble, Rammurti T.
AU - Kindwall-Keller, Tamila
AU - Nishihori, Taiga
AU - Olsson, Richard F.
AU - Ramanathan, Muthalagu
AU - Saad, Ayman A.
AU - Solh, Melhem
AU - Ustun, Celalettin
AU - Valcárcel, David
AU - Warlick, Erica
AU - Wirk, Baldeep M.
AU - Kalaycio, Matt
AU - Alyea, Edwin
AU - Popat, Uday
AU - Sobecks, Ronald
AU - Saber, Wael
N1 - Publisher Copyright:
© 2017 The American Society for Blood and Marrow Transplantation
PY - 2017/6
Y1 - 2017/6
N2 - 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.
AB - 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.
KW - Blood and marrow transplantation
KW - Myelodysplastic syndrome
KW - Umbilical cord transplantation
UR - http://www.scopus.com/inward/record.url?scp=85017378656&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85017378656&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2017.03.014
DO - 10.1016/j.bbmt.2017.03.014
M3 - Article
C2 - 28288952
AN - SCOPUS:85017378656
SN - 1083-8791
VL - 23
SP - 971
EP - 979
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 6
ER -