Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Comparison of long-term outcome for AML patients alive free of disease 2 years after allogeneic hematopoietic cell transplantation with umbilical cord blood versus unrelated donor: a study from the ALWP of the EBMT

Bone Marrow Transplantation volume 56, pages 2742–2748 (2021)Cite this article

Subjects

Abstract

Since cord blood transplantation (CBT) has been associated with high graft-versus-leukemia effects and a low incidence of chronic graft-versus-host disease (GVHD), we hypothesized that long-term outcomes might be better in CBT patients than in those given grafts from unrelated donors (UD). Therefore, we performed a landmark study comparing long-term outcomes in acute myeloid leukemia (AML) patients alive and disease-free 2 years after transplantation who received grafts from either CBT or UD. A total of 364 CBT recipients, 2648 UD 10/10 patients and 681 patients given grafts from UD 9/10 were included. Median follow-up was 6.0 years. Five-year leukemia-free survival (LFS) from transplantation was 86% in CBT patients, 84% in UD 10/10 patients (P = 0.36) and 84% in UD 9/10 patients (P = 0.86). On multivariate analysis, donor type had no impact on LFS. Similarly, no impact of donor type was observed on relapse incidence or non-relapse mortality. Factors associated with poorer LFS on multivariate analysis included higher age at transplantation (P < 0.001), male gender (P < 0.001), second complete remission (CR2) versus CR1 (P = 0.05), secondary AML (P = 0.01), antecedent of chronic GVHD (P < 0.001) and poor-risk cytogenetics (P = 0.01). In conclusion, our study shows that long-term outcome for AML patients in CR two years after transplantation is not impacted by donor type.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Long-term transplantation outcomes according to donor type in AML patients alive and in CR, 2 years after transplantation.

Similar content being viewed by others

References

  1. Dohner H, Estey E, Grimwade D, Amadori S, Appelbaum FR, Buchner T, et al. Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel. Blood. 2017;129:424–47.

    Article  Google Scholar 

  2. Baron F, Efficace F, Cannella L, Muus P, Trisolini S, Halkes CJM, et al. Impact of the type of anthracycline and of stem cell transplantation in younger patients with acute myeloid leukemia: Long-term follow up of a phase III study. Am J Hematol. 2020;95:749–58.

    Article  CAS  Google Scholar 

  3. Baron F, Stevens-Kroef M, Kicinski M, Meloni G, Muus P, Marie J-P, et al. Impact of induction regimen and allogeneic hematopoietic cell transplantation on outcome in younger adults with acute myeloid leukemia with a monosomal karyotype. Haematologica. 2019;104:1168–75.

    Article  CAS  Google Scholar 

  4. Baron F, Efficace F, Cannella L, Willemze R, Vignetti M, Muus P, et al. Long-term follow-up of a trial comparing post-remission treatment with autologous or allogeneic bone marrow transplantation or intensive chemotherapy in younger acute myeloid leukemia patients. Haematologica. 2020;105:e13–e16.

    Article  Google Scholar 

  5. Baron F, Labopin M, Blaise D, Itälä-Remes M, Socié G, Forcade E, et al. Better leukemia-free survival with allogeneic than with autologous HCT in AML patients with isolated trisomy 8: a study from the ALWP of the EBMT. Bone Marrow Transpl. 2020. https://doi.org/10.1038/s41409-020-01051-6.

  6. Eapen M, Rocha V, Sanz G, Scaradavou A, Zhang M-J, Arcese W, et al. Effect of graft source on unrelated donor haemopoietic stem-cell transplantation in adults with acute leukaemia: a retrospective analysis. Lancet Oncol. 2010;11:653–60.

    Article  Google Scholar 

  7. Konuma T, Tsukada N, Kanda J, Uchida N, Ohno Y, Miyakoshi S, et al. Comparison of transplant outcomes from matched sibling bone marrow or peripheral blood stem cell and unrelated cord blood in patients 50 years or older. Am J Hematol. 2016;91:E284–292.

    Article  Google Scholar 

  8. Baron F, Labopin M, Ruggeri A, Cornelissen JJ, Meijer E, Sengeloev H, et al. Impact of donor type in patients with AML given allogeneic hematopoietic cell transplantation after low-dose TBI-Based Regimen. Clin Cancer Res. 2018;24:2794–803.

    Article  CAS  Google Scholar 

  9. Socié G, Stone JV, Wingard JR, Weisdorf D, Henslee-Downey PJ, Bredeson C, et al. Long-term survival and late deaths after allogeneic bone marrow transplantation. Late Effects Working Committee of the International Bone Marrow Transplant Registry. N Engl J Med. 1999;341:14–21.

    Article  Google Scholar 

  10. Shimoni A, Labopin M, Savani B, Byrne M, Volin L, Finke J, et al. Comparable long-term outcome after allogeneic stem cell transplantation from sibling and matched unrelated donors in patients with acute myeloid leukemia older than 50 years: a report on behalf of the acute leukemia working party of the European Society for Blood and Marrow Transplantation. Biol Blood Marrow Transpl. 2019;25:2251–60.

    Article  Google Scholar 

  11. Baron F, Ruggeri A, Beohou E, Labopin M, Mohty M, Sanz J, et al. Occurrence of graft-versus-host disease increases mortality after umbilical cord blood transplantation for acute myeloid leukaemia: a report from Eurocord and the ALWP of the EBMT. J Intern Med. 2018;283:178–89.

    Article  CAS  Google Scholar 

  12. Milano F, Gooley T, Wood B, Woolfrey A, Flowers ME, Doney K, et al. Cord-blood transplantation in patients with minimal residual disease. N Engl J Med. 2016;375:944–53.

    Article  Google Scholar 

  13. Wagner JEJ, Brunstein CG, Boitano AE, DeFor TE, McKenna D, Sumstad D, et al. Phase I/II trial of stemregenin-1 expanded umbilical cord blood hematopoietic stem cells supports testing as a stand-alone graft. Cell Stem Cell. 2016;18:144–55.

    Article  CAS  Google Scholar 

  14. Cohen S, Roy J, Lachance S, Delisle J-S, Marinier A, Busque L, et al. Hematopoietic stem cell transplantation using single UM171-expanded cord blood: a single-arm, phase 1-2 safety and feasibility study. Lancet Haematol. 2020;7:e134–e145.

    Article  Google Scholar 

  15. Passweg JR, Baldomero H, Chabannon C, Basak GW, Corbacioglu S, Duarte R, et al. The EBMT activity survey on hematopoietic-cell transplantation and cellular therapy 2018: CAR-T’s come into focus. Bone Marrow Transpl. 2020;55:1604–13.

    Article  Google Scholar 

  16. Canaani J, Labopin M, Itälä-Remes M, Blaise D, Socié G, Forcade E, et al. Prognostic significance of recurring chromosomal abnormalities in transplanted patients with acute myeloid leukemia. Leukemia. 2019;33:1944–52.

    Article  CAS  Google Scholar 

  17. Verneris MR, Brunstein CG, Barker J, MacMillan ML, DeFor T, McKenna DH, et al. Relapse risk after umbilical cord blood transplantation: enhanced graft-versus-leukemia effect in recipients of 2 units. Blood. 2009;114:4293–9.

    Article  CAS  Google Scholar 

  18. Baron F, Labopin M, Ruggeri A, Sierra J, Robinson S, Labussière-Wallet H, et al. Impact of detectable measurable residual disease on umbilical cord blood transplantation. Am J Hematol. 2020. https://doi.org/10.1002/ajh.25879.

  19. Baker KS, Leisenring WM, Goodman PJ, Ermoian RP, Flowers ME, Schoch G, et al. Total body irradiation dose and risk of subsequent neoplasms following allogeneic hematopoietic cell transplantation. Blood. 2019;133:2790–9.

    Article  CAS  Google Scholar 

  20. Syrjala KL, Martin PJ, Lee SJ. Delivering care to long-term adult survivors of hematopoietic cell transplantation. J Clin Oncol. 2012;30:3746–51.

    Article  Google Scholar 

  21. Finke J, Schmoor C, Bethge WA, Ottinger H, Stelljes M, Volin L, et al. Long-term outcomes after standard graft-versus-host disease prophylaxis with or without anti-human-T-lymphocyte immunoglobulin in haemopoietic cell transplantation from matched unrelated donors: final results of a randomised controlled trial. Lancet Haematol. 2017;4:e293–e301.

    Article  Google Scholar 

  22. Bonifazi F, Solano C, Wolschke C, Sessa M, Patriarca F, Zallio F, et al. Acute GVHD prophylaxis plus ATLG after myeloablative allogeneic haemopoietic peripheral blood stem-cell transplantation from HLA-identical siblings in patients with acute myeloid leukaemia in remission: final results of quality of life and long-term outcome analysis of a phase 3 randomised study. Lancet Haematol. 2019;6:e89–e99.

    Article  Google Scholar 

  23. Baron F, Mohty M, Blaise D, Socie G, Labopin M, Esteve J, et al. Anti-thymocyte globulin as graft-versus-host disease prevention in the setting of allogeneic peripheral blood stem cell transplantation: a review from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Haematologica. 2017;102:224–34.

    Article  CAS  Google Scholar 

  24. Pascal L, Mohty M, Ruggeri A, Tucunduva L, Milpied N, Chevallier P, et al. Impact of rabbit ATG-containing myeloablative conditioning regimens on the outcome of patients undergoing unrelated single-unit cord blood transplantation for hematological malignancies. Bone Marrow Transpl. 2015;50:45–50.

    Article  CAS  Google Scholar 

  25. Ringdén O, Labopin M, Ehninger G, Niederwieser D, Olsson R, Basara N, et al. Reduced intensity conditioning compared with myeloablative conditioning using unrelated donor transplants in patients with acute myeloid leukemia. J Clin Oncol. 2009;27:4570–7.

    Article  Google Scholar 

  26. Baron F, Ruggeri A, Beohou E, Labopin M, Sanz G, Milpied N, et al. RIC versus MAC UCBT in adults with AML: a report from Eurocord, the ALWP and the CTIWP of the EBMT. Oncotarget. 2016;7:43027–38.

    Article  Google Scholar 

  27. Scott BL, Pasquini MC, Logan BR, Wu J, Devine SM, Porter DL, et al. Myeloablative versus reduced-intensity hematopoietic cell transplantation for acute myeloid leukemia and myelodysplastic syndromes. J Clin Oncol. 2017;35:1154–61.

    Article  Google Scholar 

Download references

Acknowledgements

We thank Emmanuelle Polge and Audrey Mailhol from the office of the ALWP of the EBMT. FB is Senior Research Associate at the National Fund for Scientific Research (FNRS) Belgium. The list of participating centers is provided in the Supplementary Appendix 1.

Author information

Authors and Affiliations

  1. Laboratory of Hematology, GIGA-I3, University of Liege and CHU of Liège, Liege, Belgium

    Frédéric Baron

  2. EBMT Paris study office / CEREST-TC, Paris, France

    Maud Ngoya, Myriam Labopin, Arnon Nagler & Mohamad Mohty

  3. Department of Haematology, Saint Antoine Hospital, Paris, France

    Myriam Labopin & Mohamad Mohty

  4. INSERM UMR 938, Paris, France

    Myriam Labopin & Mohamad Mohty

  5. Sorbonne University, Paris, France

    Myriam Labopin & Mohamad Mohty

  6. Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Hematology, Rotterdam, The Netherlands

    Jan J. Cornelissen

  7. Hannover Medical School, Department of Haematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover, Germany

    Arnold Ganser

  8. CHU Bordeaux, Hôpital Haut-leveque, Pessac, France

    Edouard Forcade

  9. Bone Marrow Transplant Unit L 4043, National University Hospital, Copenhagen, Denmark

    Henrik Sengeloev

  10. Hopital St. Louis, Dept.of Hematology—BMT, Paris, France

    Gérard Socié

  11. Programme de Transplantation&Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France

    Didier Blaise

  12. University Hospital, Medizinische Klinik und Poliklinik I TU, Dresden, Germany

    Martin Bornhäuser

  13. University Medical Center Schleswig-Holstein, Campus Kiel, Section for Stem Cell Transplantation and Immunotherapy, Kiel, Germany

    Thomas Valerius

  14. University of Duisburg-Essen, University Hospital Essen, Dept. of Hematology and Stem Cell Transplantation, Essen, Germany

    Hans Christian Reinhardt

  15. University Hospital Eppendorf, Department of Stem Cell Transplantation, Hamburg, Germany

    Nicolaus Kröger

  16. Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Annalisa Ruggeri

  17. Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Ramat-Gan, Israel

    Arnon Nagler

Authors
  1. Frédéric Baron
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maud Ngoya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Myriam Labopin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan J. Cornelissen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Arnold Ganser
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Edouard Forcade
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Henrik Sengeloev
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gérard Socié
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Didier Blaise
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Martin Bornhäuser
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Thomas Valerius
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hans Christian Reinhardt
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Nicolaus Kröger
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Annalisa Ruggeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Arnon Nagler
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Mohamad Mohty
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

FB wrote the manuscript, designed the study, and interpreted the data; MN and ML designed the study, analyzed and interpreted the data, and edited the manuscript; AN and MM designed the study, interpreted the data and edited the manuscript; JC, AG, EF, HS, GS, DB, MB, TV, HCR, NK, and AR reviewed and/or edited the manuscript and provided clinical data. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Frédéric Baron.

Ethics declarations

Competing interests

FB has received travel grants and/or speaker honoraria from Celgene, AbbVie, Novartis, Pfizer, and Sanofi. HCR received consulting and lecture fees from Abbvie, AstraZeneca, Vertex and Merck. HCR received research funding from Gilead Pharmaceuticals. HCR is a co-founder of CDL Therapeutics GmbH. The other authors declare that they have no relevant conflict of interest in relation to this study.

Ethics approval and consent to participate

The scientific board of the ALWP of the EBMT approved this study. All patients gave informed consent to participate in retrospective studies.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baron, F., Ngoya, M., Labopin, M. et al. Comparison of long-term outcome for AML patients alive free of disease 2 years after allogeneic hematopoietic cell transplantation with umbilical cord blood versus unrelated donor: a study from the ALWP of the EBMT. Bone Marrow Transplant 56, 2742–2748 (2021). https://doi.org/10.1038/s41409-021-01387-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41409-021-01387-7

This article is cited by

Search

Advanced search

Quick links