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Impact of donor types on reduced-intensity conditioning allogeneic stem cell transplant for mature lymphoid malignancies

Bone Marrow Transplantation volume 57, pages 243–251 (2022)Cite this article

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Abstract

We retrospectively compared the outcomes of reduced-intensity conditioning (RIC) transplantation from matched related donors (MRD; n = 266), matched unrelated donors (MUD; n = 277), and umbilical cord blood (UCB; n = 513) for mature lymphoid malignancies. The 3-year overall survival rates for the MRD, MUD, and UCB groups were 54%, 59%, and 40%, respectively (P < 0.001). Multivariate analysis showed no differences in survival between the MRD group and the MUD or UCB group. However, survival was significantly affected by the conditioning regimen and graft-versus-host disease (GVHD) prophylaxis in the UCB group, but not in the MRD and MUD groups. Notably, multivariate analysis showed that the risk of overall mortality in the UCB recipients who received the optimal conditioning regimen and GVHD prophylaxis (n = 116) was lower than that in the MRD group (relative risk [RR], 0.69; P = 0.03) and tended to be lower than that in the MUD group (RR, 0.75; P = 0.09). Our results suggest that UCB transplantation performed with the optimal conditioning regimen and GVHD prophylaxis is highly effective. Moreover, UCB is readily available. Thus, UCB transplantation with the optimal conditioning regimen and GVHD prophylaxis is preferable to MUD transplantation when MRD are not available in the setting of RIC transplantation for mature lymphoid malignancies.

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Fig. 1: Overall survival of the MRD, MUD, and UCB groups.
Fig. 2: Overall survival, relapse/progression, and NRM of the MRD, MUD, optimal UCB, and suboptimal UCB groups.
Fig. 3: Hematopoietic recovery and GVHD of the MRD, MUD, optimal UCB, and suboptimal UCB groups.
Fig. 4: Forest plots showing the impact of the donor type on the OS of different subgroups of patients.

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Acknowledgements

We thank all staff members of the collaborating institutions of the Japan Society for Hematopoietic Cell Transplantation (JSHCT) and all the members of the data management committees of the JSHCT. This work was supported in part in part by a Grant-in-Aid for Scientific Research (KAKENHI 19K17854 to NI) from the Japan Society for the Promotion of Science (JSPS) and the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from the Japan Agency for Medical Research and Development, AMED, under grant number 19ek0510023h0002.

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Authors and Affiliations

  1. Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan

    Nobuhiko Imahashi

  2. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Seitaro Terakura

  3. Department of Hematology, Kawasaki Medical School, Kurashiki, Japan

    Eisei Kondo

  4. Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Science, Fukuoka, Japan

    Koji Kato

  5. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    Sung-Won Kim & Takahiro Fukuda

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

    Akihito Shinohara

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

    Mizuki Watanabe, Tadakazu Kondo & Junya Kanda

  8. Department of Hematology, Toranomon Hospital, Tokyo, Japan

    Naoyuki Uchida

  9. Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan

    Hikaru Kobayashi

  10. Department of Hematology, Osaka International Cancer Institute, Osaka, Japan

    Jun Ishikawa

  11. Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    Keisuke Kataoka

  12. Division of Molecular Oncology, National Cancer Center Research Institute, Tokyo, Japan

    Keisuke Kataoka

  13. Department of Hematology, Hokkaido University Hospital, Sapporo, Japan

    Souichi Shiratori

  14. Division of Hematology and Stem Cell Transplantation, Shizuoka Cancer Center, Shizuoka, Japan

    Takashi Ikeda

  15. Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan

    Ken-ichi Matsuoka

  16. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    Shuro Yoshida

  17. Preparation Department, Japanese Red Cross Kinki Block Blood Center, Osaka, Japan

    Takafumi Kimura

  18. Department of Hematology/Oncology, Tokai University School of Medicine, Isehara, Japan

    Makoto Onizuka

  19. Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Tatsuo Ichinohe

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

    Yoshiko Atsuta

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

    Yoshiko Atsuta

Authors
  1. Nobuhiko Imahashi
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Contributions

NI designed the research, analyzed the data, and wrote the manuscript. ST, EK, K. Kato, SWK, AS, MW, and JK analyzed the data and helped write the manuscript. TF, NU, HK, JI, K. Kataoka, SS, T. Ikeda, KM, TE, and T. Kondo collected the patient data. T. Kimura, MO, T. Ichinohe, and YA supervised the data management. JK and EK designed and supervised the research. All authors reviewed and approved the final version of the manuscript.

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Correspondence to Nobuhiko Imahashi.

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Competing interests

EK received speaker honoraria from Sumitomo Dainippon Pharma Co. and Takeda Pharmaceutical Co. T. Ichinohe has received speaker honoraria from Bristol-Myers Squibb, Celgene, Janssen Pharmaceutical K.K., and Kyowa Kirin Co. and research funding from Astellas Pharma, Chugai Pharmaceutical Co., CSL Behring, Eisai Co., FUJIFILM Wako Chemicals., Kyowa Kirin Co., Ono Pharmaceutical Co., Pfizer, Nippon Shinyaku Co., MSD, Otsuka Pharmaceutical Co., Repertoire Genesis Inc., Sumitomo Dainippon Pharma Co., Taiho Pharmaceutical Co., Takara Bio Inc., Takeda Pharmaceutical Co., and Zenyaku Kogyo Co. The other authors declare no competing interests.

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Imahashi, N., Terakura, S., Kondo, E. et al. Impact of donor types on reduced-intensity conditioning allogeneic stem cell transplant for mature lymphoid malignancies. Bone Marrow Transplant 57, 243–251 (2022). https://doi.org/10.1038/s41409-021-01525-1

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