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Graft-versus-host Disease

Clinical separation of cGvHD and GvL and better GvHD-free/relapse-free survival (GRFS) after unrelated cord blood transplantation for AML

Bone Marrow Transplantation volume 52, pages 88–94 (2017)Cite this article

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Abstract

Few studies have presented a comparison of myeloablative cord blood transplantation (CBT) and HLA-identical sibling hematopoietic cell transplantation (HCT) for AML in a disease-specific analysis, and the evaluation of GvHD-free and relapse-free survival (GRFS) in AML patients after unrelated CBT has not been reported. A total of 162 consecutive AML patients receiving intensified myeloablative unrelated CBT (n=107) or allogeneic PBSC transplantation (allo-PBSCT) or bone marrow transplantation (BMT) from an HLA-identical sibling donor (n=55) were investigated. Neutrophil or platelet engraftment was slower in the CBT cohort compared with that in the allo-PBSCT/BMT cohort. The incidence of grade II–IV or grade III–IV acute GvHD (aGvHD) and transplant-related mortality (TRM) were not significantly different in the two cohorts. Compared with the allo-PBSCT/BMT cohort, the CBT cohort had a significantly lower rate of chronic GvHD (cGvHD) (13.7% vs 28.3%; P=0.047) or extensive cGvHD (9.9% vs 24.1%; hazard ratio (HR)=2.06, P=0.039). The incidence of relapse at 5 years in the CBT cohort was significantly lower than that in the allo-PBSCT/BMT cohort (15.3% vs 36.1%; HR=4.62, P=0.009). The probabilities of overall survival and leukemia-free survival were similar between the two cohorts. The adjusted 5-year probability of GRFS was higher after CBT than that after allo-PBSCT/BMT (55.4% vs 39.2%; HR=1.63, P=0.042). The present study suggests that, for AML patients, intensified myeloablative unrelated CBT is associated with less cGvHD and a lower risk of relapse. In addition, these patients do not experience excessive TRM or severe aGvHD that translates into better GRFS compared with those patients who undergo HLA-identical sibling allo-PBSCT/BMT; this observation may reflect the clinical separation between cGvHD and GvL within our CBT protocol.

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (No. 81570159 and 81470350), Anhui Provincial Natural Science Foundation of China (No. 1608085MH181) and Anhui Provincial Public Welfare Technology Application Research linkage project in 2015 (No. 1501ld04020).

Author contributions

C-CZ and Z-MS designed the study, performed the research, provided and analyzed the data. C-CZ wrote the paper. B-LT, X-YZ, X-HZ, LZ, L-QG and H-LL provided data, edited the paper and contributed to the analysis of research.

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  1. Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China

    C-C Zheng, X-Y Zhu, B-L Tang, X-H Zhang, L Zhang, L-Q Geng, H-L Liu & Z-M Sun

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Correspondence to Z-M Sun.

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Zheng, CC., Zhu, XY., Tang, BL. et al. Clinical separation of cGvHD and GvL and better GvHD-free/relapse-free survival (GRFS) after unrelated cord blood transplantation for AML. Bone Marrow Transplant 52, 88–94 (2017). https://doi.org/10.1038/bmt.2016.182

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