TY - JOUR
T1 - Unrelated cord blood transplantation with myeloablative conditioning for pediatric acute lymphoblastic leukemia in remission
T2 - prognostic factors
AU - Kawahara, Yuta
AU - Morimoto, Akira
AU - Inagaki, Jiro
AU - Koh, Katsuyoshi
AU - Noguchi, Maiko
AU - Goto, Hiroaki
AU - Yoshida, Nao
AU - Cho, Yuko
AU - Hori, Tsukasa
AU - Hiwatari, Mitsuteru
AU - Kato, Keisuke
AU - Ogawa, Atsushi
AU - Hashii, Yoshiko
AU - Inoue, Masami
AU - Kato, Koji
AU - Atsuta, Yoshiko
AU - Kimura, Fumihiko
AU - Kato, Motohiro
N1 - Funding Information:
Acknowledgements We thank all the staff at the hospitals and centers who contributed valuable data to the JSHCT registry. We also thank all the members of the data management committees of the JSHCT. This work was supported in part by the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from Japan Agency for Medical Research and Development, AMED, under Grant Number 19ek0510023h0002.
Publisher Copyright:
© 2020, The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2021/2
Y1 - 2021/2
N2 - The number of individuals undergoing unrelated cord blood transplantation (UCBT) has increased in recent years; however, information on prognostic factors is limited. We retrospectively analyzed data from 475 children and adolescents receiving UCBT with myeloablative conditioning for acute lymphoblastic leukemia (ALL) in complete remission (CR), based on a nationwide registry. In the total patient cohort, 5-year leukemia-free survival (LFS) and overall survival (OS) rates after UCBT were 61.1% and 67.7%, respectively. UCBT at first CR and UCBT after 2007 were associated with good survival, while grade II–IV acute graft-versus-host disease (GVHD) was associated with low relapse rate but did not affect survival. Analysis according to human leukocyte antigen (HLA) disparity revealed that tacrolimus-based GVHD prophylaxis resulted in higher OS and lower relapse rate and nonrelapse mortality (NRM) than cyclosporine-based GVHD prophylaxis in patients transplanted with 6/6 and ≤4/6 HLA-matched umbilical cord blood. Furthermore, grade II–IV acute GVHD was associated with good LFS and low relapse rate, without high NRM, in patients receiving 5/6 HLA-matched UCBT. These data indicate that prognostic factors for ALL differ depending on HLA disparity in UCBT.
AB - The number of individuals undergoing unrelated cord blood transplantation (UCBT) has increased in recent years; however, information on prognostic factors is limited. We retrospectively analyzed data from 475 children and adolescents receiving UCBT with myeloablative conditioning for acute lymphoblastic leukemia (ALL) in complete remission (CR), based on a nationwide registry. In the total patient cohort, 5-year leukemia-free survival (LFS) and overall survival (OS) rates after UCBT were 61.1% and 67.7%, respectively. UCBT at first CR and UCBT after 2007 were associated with good survival, while grade II–IV acute graft-versus-host disease (GVHD) was associated with low relapse rate but did not affect survival. Analysis according to human leukocyte antigen (HLA) disparity revealed that tacrolimus-based GVHD prophylaxis resulted in higher OS and lower relapse rate and nonrelapse mortality (NRM) than cyclosporine-based GVHD prophylaxis in patients transplanted with 6/6 and ≤4/6 HLA-matched umbilical cord blood. Furthermore, grade II–IV acute GVHD was associated with good LFS and low relapse rate, without high NRM, in patients receiving 5/6 HLA-matched UCBT. These data indicate that prognostic factors for ALL differ depending on HLA disparity in UCBT.
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U2 - 10.1038/s41409-020-01019-6
DO - 10.1038/s41409-020-01019-6
M3 - Article
C2 - 32782350
AN - SCOPUS:85089288370
SN - 0268-3369
VL - 56
SP - 357
EP - 367
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 2
ER -
