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Comparing cord blood transplantation and matched related donor transplantation in non-remission acute myeloid leukemia


Cord blood transplantation (CBT) is an alternative donor transplantation method and has the advantages of rapid availability and the possibility of inducing a more potent graft-versus-leukemia effect, leading to a lower relapse rate for patients with non-remission relapse and refractory acute myeloid leukemia (R/R AML). This study aimed to investigate the impact of CBT, compared to human leukocyte antigen-matched related donor transplantation (MRDT). This study included 2451 adult patients with non-remission R/R AML who received CBT (1738 patients) or MRDT (713 patients) between January 2009 and December 2018. Five-year progression-free survival (PFS) and the prognostic impact of CBT were evaluated using a propensity score (PS) matching analysis. After PS matching, the patient characteristics were well balanced between the groups. The five-year PFS was 25.2% (95% confidence interval [CI]: 21.2–29.5%) in the CBT group and 18.1% (95% CI: 14.5–22.0%) in the MRDT group (P = 0.009). The adjusted hazard ratio (HR) was 0.83 (95% CI: 0.69–1.00, P = 0.045); this was due to a more pronounced decrease in the relapse rate (HR: 0.78, 95% CI: 0.69–0.89, P < 0.001) than an increase in the NRM (1.42, 1.15–1.76, P = 0.001). In this population, CBT was associated with a better 5-year PFS than MRDT after allogeneic HSCT.

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Fig. 1: Patient selection process.
Fig. 2: Transplant outcomes in a propensity score-matched cohort.


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The authors thank all the physicians and data managers of the centers, who contributed to the collection of data on transplantation for the Japanese Data Center for Hematopoietic Cell Transplantation and the Transplant Registry Unified Management Program 2. We would like to express our gratitude to the Japan Society of Clinical Research for their support.

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YS designed the study, analyzed the data, performed the statistical analysis, and wrote the first draft of the manuscript. TS, SH, TK, SM, JK, TF, KK and MY critically reviewed the manuscript and analyzed data. All the other authors contributed to data collection. All authors approved the final version.

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Correspondence to Yoshimitsu Shimomura.

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Shimomura, Y., Sobue, T., Hirabayashi, S. et al. Comparing cord blood transplantation and matched related donor transplantation in non-remission acute myeloid leukemia. Leukemia (2021).

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