Prospective Randomized Study Comparing Myeloablative Unrelated Umbilical Cord Blood Transplantation versus HLA-Haploidentical Related Stem Cell Transplantation for Adults with Hematologic Malignancies
Por:
Sanz, J, Montoro, J, Solano, C, Valcarcel, D, Sampol, A, Ferra, C, Parody, R, Lorenzo, I, Montesinos, P, Orti, G, Hernandez-Boluda, JC, Balaguer-Rosello, A, Guerreiro, M, Carretero, C, Sanz, GF, Sanz, MA and Pinana, JL
Publicada:
1 feb 2020
Ahead of Print:
23 oct 2019
Resumen:
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. (C) 2019 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
Filiaciones:
Sanz, J:
Hosp Univ & Politecn La Fe, Inst Invest Sanitaria La Fe, Hematol Dept, Valencia, Spain
Inst Carlos III, Ctr Invest Biomed Red Canc, Madrid, Spain
Univ Valencia, Dept Med, Valencia, Spain
Montoro, J:
Hosp Univ & Politecn La Fe, Inst Invest Sanitaria La Fe, Hematol Dept, Valencia, Spain
Solano, C:
Univ Valencia, Dept Med, Valencia, Spain
Hosp Clin Univ Valencia, Hematol Dept, Valencia, Spain
Valcarcel, D:
Hosp Univ Vall dHebron, Hematol Dept, Barcelona, Spain
Sampol, A:
Hosp Univ Son Espases, Hematol Dept, Palma De Mallorca, Spain
:
Univ Autonoma Barcelona, Hosp Germans Trias & Pujol, Inst Recerca Leucemia Josep Carreras, Inst Catala Oncol,Hematol Dept, Badalona, Spain
Parody, R:
Hosp Duran & Reynals, Inst Catalan Oncol, Hematol Dept, Barcelona, Spain
Lorenzo, I:
Hosp Univ & Politecn La Fe, Inst Invest Sanitaria La Fe, Hematol Dept, Valencia, Spain
Inst Carlos III, Ctr Invest Biomed Red Canc, Madrid, Spain
Montesinos, P:
Hosp Univ & Politecn La Fe, Inst Invest Sanitaria La Fe, Hematol Dept, Valencia, Spain
Inst Carlos III, Ctr Invest Biomed Red Canc, Madrid, Spain
Orti, G:
Hosp Univ Vall dHebron, Hematol Dept, Barcelona, Spain
Hernandez-Boluda, JC:
Univ Valencia, Dept Med, Valencia, Spain
Hosp Clin Univ Valencia, Hematol Dept, Valencia, Spain
Balaguer-Rosello, A:
Hosp Univ & Politecn La Fe, Inst Invest Sanitaria La Fe, Hematol Dept, Valencia, Spain
Guerreiro, M:
Hosp Univ & Politecn La Fe, Inst Invest Sanitaria La Fe, Hematol Dept, Valencia, Spain
Carretero, C:
Hosp Univ & Politecn La Fe, Inst Invest Sanitaria La Fe, Hematol Dept, Valencia, Spain
Sanz, GF:
Hosp Univ & Politecn La Fe, Inst Invest Sanitaria La Fe, Hematol Dept, Valencia, Spain
Inst Carlos III, Ctr Invest Biomed Red Canc, Madrid, Spain
Univ Valencia, Dept Med, Valencia, Spain
Sanz, MA:
Hosp Univ & Politecn La Fe, Inst Invest Sanitaria La Fe, Hematol Dept, Valencia, Spain
Inst Carlos III, Ctr Invest Biomed Red Canc, Madrid, Spain
Univ Valencia, Dept Med, Valencia, Spain
Pinana, JL:
Hosp Univ & Politecn La Fe, Inst Invest Sanitaria La Fe, Hematol Dept, Valencia, Spain
Inst Carlos III, Ctr Invest Biomed Red Canc, Madrid, Spain
Green Published
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