Comparison of haploidentical and umbilical cord blood transplantation after myeloablative conditioning

John E. Wagner, Karen K. Ballen, Mei Jie Zhang, Mariam Allbee-Johnson, Chatchada Karanes, Filippo Milano, Michael R. Verneris, Mary Eapen, Claudio G. Brunstein

Research output: Contribution to journalArticlepeer-review

Abstract

Haploidentical hematopoietic stem cell transplantation (haplo-HSCT) has emerged as an important treatment modality. Most reports comparing haplo-HSCT with posttransplant cyclophosphamide (PTCy) and other donor sources have focused on outcomes in older adults treated with reduced intensity conditioning. Therefore, in the current study, we evaluated outcomes in patients with hematological malignancy treated with myeloablative conditioning prior to haplo- (n = 375) or umbilical cord blood (UCB; n = 333) HSCT. All haplo recipients received a 4 of 8 HLA-matched graft, whereas recipients of UCB were matched at 6-8/8 (n = 145) or ≤5/8 (n = 188) HLA antigens. Recipients of 6-8/8 UCB transplants were younger (14 years vs 21 and 29 years) and more likely to have lower comorbidity scores compared with recipients of ≤5/8 UCB and haplo-HSCT (81% vs 69% and 63%, respectively). UCB recipients were more likely to have acute lymphoblastic leukemia and transplanted in second complete remission (CR), whereas haplo-HSCT recipients were more likely to have acute myeloid leukemia in the first CR. Other characteristics, including cytogenetic risk, were similar. Survival at 3 years was similar for the donor sources (66% haplo- and 61% after ≤5/8 and 58% after 6-8/8 UCB). Notably, relapse at 3 years was lower in recipients of ≤5/8 UCB (21%, P = .03) compared with haplo- (36%) and 6-8/8 UCB (30%). However, nonrelapse mortality was higher in ≤5/8 UCB (21%) compared with other groups (P < .0001). These data suggest that haplo-HSCT with PTCy after myeloablative conditioning provides an overall survival outcome comparable to that after UCB regardless HLA match group.

Original languageEnglish (US)
Pages (from-to)4064-4072
Number of pages9
JournalBlood Advances
Volume5
Issue number20
DOIs
StatePublished - Oct 26 2021

Bibliographical note

Funding Information:
The Center for International Blood and Marrow Transplant Research is supported primarily by Public Health Service Grant/ Cooperative Agreement U24-CA076518 from the National Institutes of Health, National Cancer Institute, the National Heart, Lung, and Blood Institute, and the National Institute of Allergy and Infectious Diseases grant HHSH250201200016C with the Health Resources and Services Administration grant P01-CA065493 (J.E.W. and C.G.B.) The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, Health Resources and Services Administration, or any other agency of the US Government.

Publisher Copyright:
© 2021 by The American Society of Hematology.

Keywords

  • Aged
  • Cord Blood Stem Cell Transplantation
  • Hematologic Neoplasms/therapy
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Leukemia, Myeloid, Acute
  • Transplantation Conditioning

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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