Unrelated Cord Blood Transplant Effective in ALL, AML
Linda Little
Medscape Medical News 2005. © 2005 Medscape
Dec. 16, 2005 (Atlanta) - Unrelated umbilical cord blood transplantation provides an efficacious alternative for leukemia patients in need of aggressive treatment and rescue, researchers reported here at the 47th annual meeting of the American Society of Hematology.
"Unrelated cord blood results were better than haplo [haploidentical t-cell depleted peripheral blood cell transplant] in acute lymphoblastic leukemia (ALL)," said Vanderson Rocha, MD, PhD, from the Hospital Saint Louis in Paris, France, on behalf of the Eurocord-Netcord group. "In the [acute] myeloid leukemia (AML) patients, the results between the 2 treatments were similar."
"This is very good because in general these patients are left without any option," Dr. Rocha told Medscape.
ALL patients receiving unrelated cord blood transplantation (UCBT) had a significantly higher 2-year leukemia-free survival (LFS) rate compared with haplo patients (36% vs 13%; P = .01) and a reduced 2-year relapse incidence (23% vs 38%; P = .07). AML patients treated with UCBT had responses similar to Haplo patients.
Both ALL and AML treated with UCBT had higher rates of graft-versus-host disease (GVHD) and slower neutrophil recovery (23 vs 13 days; P = 0001).
When leukemia patients have no HLA identical sibling or a matched unrelated donor, both haplo and UCBT are options; however, the outcomes of the strategies had not been compared in ALL, Dr. Rocha told attendees at the meeting.
The retrospective study of 368 ALL and AML patients compared the outcomes of treatment for UCBT and haplo. The study included 148 ALL patients and 220 AML patients. In the ALL group, 75 patients were treated with haplo and 73 with UCBT. In the AML group, 154 patients were treated with haplo and 66 with UCBT.
UCBT patients were significantly younger in both groups. In the ALL group, UCBT patients received less total body irradiation than those in the AML group. Advanced disease, cytogenetics, and interval after treatment were similar among the groups.
Leukemia patients treated with UCBT were 1.4 times more likely to achieve LFS at 2 years compared with haplo patients, Dr. Rocha said during his presentation.
There was not a significant difference in transplant-related mortality between the 2 treatment groups.
Both groups of UCBT patients had more acute GVHD with 28% of UCBT patients vs 8% of haplo patients (P = .004), the researcher reported. Both UCBT groups also had higher incidences of chronic GVHD, with a cumulative incidence of 38% vs 29% in ALL haplo patients (P = .07) and 30% vs 13% (P = .06) in AML patients.
It is no surprise that GVHD is higher in the UCBT patients because in haplo the T cells are removed, Dr. Rocha told Medscape. "But when the T cells are removed there also is a larger chance of relapse."
The advantage with unrelated cord blood is that it is available and can be readily ordered for such transplants, Dr. Rocha said. "In this situation, the patient doesn't have to have a family member as a donor."
To date, there are between 30 and 40 tissue banks throughout the world with about 300,000 units of cord blood, Dr. Rocha said. "This offers a rapid method for transplantation."
As many as 70% of patients are without related bone marrow donors and finding a match in unrelated donor registries can take 3 to 6 months, often too late for seriously ill patients, he said.
The use of unrelated cord blood is an advance and improvement for adults with leukemia who do not have a tissue-matched donor, said Stephen Emerson, MD, chief of hematology and oncology at the University of Pennsylvania in Pittsburgh. "It's widely available, easy to get samples, and appears to have less toxicity than bone marrow. This is a nice definitive study," he said.
Dr. Rocha reported no financial relationships.
ASH 47th Annual Meeting: Abstract 301. Presented Dec. 12, 2005.
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