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Unrelated cord blood transplantation for childhood acute myelogenous leukemia: The influence of cytogenetic risk group stratification

Leukemia volume 30, pages 1180–1183 (2016)Cite this article

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Cytogenetic analysis provides essential prognosis information in children with acute myeloid leukemia (AML) treated by chemotherapy, allowing stratification into three risk groups, namely favorable, intermediate and unfavorable.1, 2, 3 Whether this classification also predicts outcome after allogeneic hematopoietic stem cell transplantation (HSCT) has not yet been established, particularly in the context of unrelated cord blood transplantation (UCBT). From a theoretical point of view, a prognostic factor identified in the chemotherapeutic setting cannot be automatically extrapolated to transplanted patients because the efficacy of HSCT is substantially linked to alloreactivity, a mechanism clearly different from the cytostatic effect of chemotherapy. In 2003, the Eurocord group published a first report of 95 children with AML who received UCBT.4 The results were promising in the unfavorable karyotype subgroup, but the number of children in each group was relatively small and precluded any attempt to compare results according to both cytogenetic category and disease status at time of transplantation. We are now able to analyze the results of UCBT for 293 children with AML at different disease status, all with available detailed cytogenetic information.

Patients reported to the Eurocord registry were eligible for this study if they had AML, were <18-year-old at time of single unit UCBT, received myeloablative conditioning regimen and had available karyotype information. Two-hundred and ninety-three children fulfilled the study criteria (after exclusion of 23 transplanted with double units) and all were included in the analysis. Informed consent was obtained in accordance with the declaration of Helsinki. The study was approved by the Eurocord institutional review board. Children were stratified in three prognostic groups of risk, favorable, intermediate and unfavorable.5, 6, 7, 8, 9 Favorable risk was defined as either core binding factor (CBF) AML or t(15;17), irrespective of additional cytogenetic abnormalities. Unfavorable risk was defined as presence of monosomy 7 or del(7q), monosomy 5 or del(5q), inv3(q21q26)/t(3;3)(q21;q26), t(6;9)(p23;q34), t(9;22)(q34;q11), 12p13 abnormalities, complex karyotype (three or more abnormalities with at least one structural abnormality and excluding CBF AML and 11q23 abnormalities) and finally 11q23 abnormalities other than t(9;11)(p21–22;q23) and t(1;11)(q21;q23). Among 11q23 abnormalities, a subgroup of most unfavorable karyotypes was defined as t(4;11)(q21;q23), t(6;11)(q27;q23), t(10;11)(p12;q23), and t(10;11)(p11.2;q23). Intermediate risk group included children with a normal karyotype or carrying abnormalities not classified as either favorable or unfavorable. Statistical methods are detailed as Supplementary Data.

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Authors and Affiliations

  1. Hôpital d'Enfants de la Timone, AP-HM and EA3279 Research Unit, Aix-Marseille University, Marseille, France

    G Michel & C Oudin

  2. Eurocord, Hôpital Saint Louis AP-HP, University Paris VII IUH, Paris, France

    R Cunha, A Ruggeri, F Giannotti, F Volt, E Gluckman & V Rocha

  3. Hôpital Saint Antoine, Service d’Hématologie et Thérapie Cellulaire, AP-HP, Paris, France

    A Ruggeri & F Giannotti

  4. Kids Cancer Centre Sydney Children’s Hospital, Randwick, NSW, Australia

    T A O'Brien

  5. Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada

    H Bittencourt

  6. Hôpital Robert Debré, APHP, Paris Diderot University, PRES Sorbonne Paris Cité, Paris, France

    J H Dalle

  7. Dipartimento di Oncoematologia Pediatrica, Ospedale Bambino Gesù, IRCSS, Roma, Università di Pavia, Pavia, Italy

    F Locatelli

  8. Dipartimento Biotecnologie Cellulari ed Ematologia, Università La Sapienza, Rome, Italy

    A P Iori

  9. Hospital Amaral Carvalho, Jau, Brazil

    M Mauad

  10. Monacord, Centre Scientifique de Monaco, Monaco, France

    E Gluckman

  11. University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany

    P Bader

  12. Churchill Hospital, Oxford University, Oxford, UK

    V Rocha

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  1. G Michel
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  15. V Rocha
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on behalf of Eurocord, Cord Blood Committee of Cellular Therapy Immunobiology and Pediatric Disease Working parties of EBMT

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Correspondence to G Michel.

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The authors declare no conflict of interest.

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Supplementary Information accompanies this paper on the Leukemia website

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Michel, G., Cunha, R., Ruggeri, A. et al. Unrelated cord blood transplantation for childhood acute myelogenous leukemia: The influence of cytogenetic risk group stratification. Leukemia 30, 1180–1183 (2016). https://doi.org/10.1038/leu.2015.243

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