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High-dose cytarabine added to CY/TBI improves the prognosis of cord blood transplantation for acute lymphoblastic leukemia in adults: a retrospective cohort study

Bone Marrow Transplantation volume 51, pages 1636–1639 (2016)Cite this article

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Allogeneic hematopoietic cell transplantation is an effective therapy for ALL in adults, and it is highly recommended for high-risk patients such as those with older age, certain cytogenetic abnormalities and minimal residual disease (MRD).1, 2 Cord blood transplantations (CBT) are increasingly used as a stem cell source for allogeneic transplantation in ALL,3, 4, 5 and various conditioning regimens have been adopted in CBT, since its clinical introduction.6, 7, 8 Among them, high-dose cytarabine (HDCA) added to the conventional regimen of cyclophosphamide with TBI (CY/TBI) may be a promising strategy, because cytarabine has long been used as an effective agent during induction and consolidation chemotherapy for ALL.1 However, comparisons between HDCA/CY/TBI and CY/TBI are lacking, and the data on HDCA-related toxicity, as well as non-relapse mortality (NRM) and overall survival (OS) are not fully discussed. Therefore, we performed a cohort study by using the Japanese transplant registry database of ALL to compare the prognosis in patients, who underwent CBT after the HDCA/CY/TBI or CY/TBI regimen.

Data of adult patients (age⩾16 years) with ALL, who underwent a single-unit CBT as a first transplantation after CY/TBI (CY, total 120 mg/kg; TBI, 10–12 Gy) or CY/TBI plus HDCA (total dose, 6–12 g/m2) between 1 January 2000 and 31 December 2013 were obtained from the Transplant Registry Unified Management Program (TRUMP) in Japan. OS was calculated with the Kaplan–Meier method and compared by using log-rank tests. Factors with P<0.1 in the univariate analysis were subjected to a multivariate analysis by using the Cox proportional hazards model. Tumor-related mortality was defined as death without remission or after relapse,9, 10 and calculated by using Gray’s method considering NRM as a competing risk. Our protocol complied with the Declaration of Helsinki, and was approved by the Ethics Committee of Kyoto University, where the study was performed.

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Acknowledgements

We thank all the physicians and data managers at the centers who contributed valuable data on transplantation to the Japan Society for Hematopoietic Cell Transplantation, all the cord blood banks in Japan and TRUMP. This study was supported by research funding from the Ministry of Education, Science, Sports, and Culture in Japan to T Kon.

Author contributions

Y Ar designed the study, reviewed and analyzed data, and wrote the paper; T Kon, AS, JT and SM interpreted the data and revised the manuscript; ST, T Kob, NU, YO, JI, HK, MS, AY, YK, MT, TI and Y At contributed to the data collection and provided critique for the manuscript.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Y Arai & T Kondo

  2. Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan

    A Shigematsu

  3. Department of Hematology, Tokyo Women’s Medical University, Tokyo, Japan

    J Tanaka

  4. Division of Molecular Therapy, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    S Takahashi

  5. Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    T Kobayashi

  6. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan

    N Uchida

  7. Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai, Japan

    Y Onishi

  8. Department of Hematology and Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    J Ishikawa

  9. Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan

    H Kanamori

  10. Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan

    M Sawa

  11. Department of Hematology, Chiba Aoba Municipal Hospital, Chiba, Japan

    A Yokota

  12. Department of Transfusion Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan

    Y Kouzai

  13. Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan

    M Takanashi

  14. Department of Hematology and Oncology, Hiroshima University Hospital, Hiroshima, Japan

    T Ichinohe

  15. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Y Atsuta

  16. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Y Atsuta

  17. Division of Hematology, Fujita Health University, Toyoake, Japan

    S Mizuta

Authors
  1. Y Arai
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  2. T Kondo
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  4. J Tanaka
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  6. T Kobayashi
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  10. H Kanamori
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  16. Y Atsuta
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  17. S Mizuta
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on behalf of the Japan Society for Hematopoietic Cell Transplantation

Corresponding author

Correspondence to T Kondo.

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The authors declare no conflict of interest.

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Supplementary Information accompanies this paper on Bone Marrow Transplantation website

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Arai, Y., Kondo, T., Shigematsu, A. et al. High-dose cytarabine added to CY/TBI improves the prognosis of cord blood transplantation for acute lymphoblastic leukemia in adults: a retrospective cohort study. Bone Marrow Transplant 51, 1636–1639 (2016). https://doi.org/10.1038/bmt.2016.242

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