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


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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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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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 (2021).

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