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Salvage single-unit unrelated cord blood transplantation for graft failure following initial allogeneic transplantation in adult acute myeloid leukemia: trends in outcomes over the past 20 years

Bone Marrow Transplantation volume 57, pages 1848–1850 (2022)Cite this article

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Graft failure is a life-threating complication following allogeneic hematopoietic cell transplantation (HCT). The incidence of graft failure following allogeneic HCT is 5.5% [1] but varies according to the use of human leukocyte antigen (HLA)-mismatched grafts, type of graft source, conditioning intensity, disease type and disease status at allogeneic HCT, and the presence of HLA donor-specific antibodies. A second allogeneic HCT can be a useful salvage therapy for patients who experienced graft failure following initial allogeneic HCT [2]. The need for salvage allogeneic HCT is usually urgent, because prolonged pancytopenia could increase the risk of fatal infectious or non-infectious complications in patients who have experienced graft failure.

The easy and rapid availability of a graft for allogeneic HCT is one of the major advantages of cord blood transplantation (CBT) [3]. Therefore, salvage unrelated CBT has increasingly been provided for adult patients who have experienced graft failure following initial allogeneic HCT [4,5,6,7,8,9]. However, a large-scale analysis of the use of salvage CBT for graft failure has not yet been conducted solely for adult patients with acute myeloid leukemia (AML), and it is unclear whether survival and engraftment improve following salvage CBT for graft failure after initial allogeneic HCT in adult patients with AML. Here, we analyzed the trends in survival and engraftment following salvage single-unit unrelated CBT for unselected adult AML patients who experienced graft failure after initial allogeneic HCT in the real-world setting, using data from a nationwide Japanese database. Details for methods are provided in the Supplementary information.

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Fig. 1: Salvage single-unit CBT outcomes for graft failure in adults with AML according to the three time periods.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors thank all of the physicians and staff at the hospital and the cord blood banks who provided the clinical data to the Transplant Registry Unified Management Program (TRUMP) of the Japanese Data Center for Hematopoietic Cell Transplantation (JDCHCT) and the Japanese Society for Transplantation and Cellular Therapy (JSTCT). This work was supported in part by the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from Japan Agency for Medical Research and Development, AMED under grant 18ek0510023h0002.

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Authors and Affiliations

  1. Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Takaaki Konuma

  2. Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan

    Kaito Harada & Makoto Onizuka

  3. Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan

    Tadakazu Kondo

  4. Department of Hematopoietic Cell Therapy, Niigata University Medical and Dental Hospital, Niigata, Japan

    Masayoshi Masuko

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

    Naoyuki Uchida

  6. Clinical Oncology and Hematology, The Jikei University School of Medicine, Tokyo, Japan

    Shingo Yano

  7. Department of Hematology, National Hospital Organisation Kumamoto Medical Center, Kumamoto, Japan

    Toshiro Kawakita

  8. Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan

    Shuichi Ota

  9. Department of Hematology, Chiba University Hospital, Chiba, Japan

    Emiko Sakaida

  10. Department of Hematology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan

    Shigesaburo Miyakoshi

  11. Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan

    Yukiyasu Ozawa

  12. Division of Hematology, Our Lady of the Snow Social Medical Corporation St. Mary’s Hospital, Fukuoka, Japan

    Yutaka Imamura

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

    Takafumi Kimura

  14. Division of Hematology, Jichi Medical University, Tochigi, Japan

    Yoshinobu Kanda

  15. Hematopoietic Stem Cell Transplantation Division, National Cancer Hospital, Tokyo, Japan

    Takahiro Fukuda

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

    Yoshiko Atsuta

  17. Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan

    Yoshiko Atsuta

  18. Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan

    Masamitsu Yanada

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  1. Takaaki Konuma
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  18. Masamitsu Yanada
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Consortia

for the Adult Acute Myeloid Leukemia Working Group of the Japanese Society for Transplantation and Cellular Therapy

Contributions

T Konuma designed the research, analyzed the data, performed the statistical analysis, and wrote the first draft of the paper. KH, T Kondo, and MY contributed to the critical review of the paper. All the other authors contributed to data collection. All authors approved the final version.

Corresponding author

Correspondence to Takaaki Konuma.

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Competing interests

The authors declare no competing interests.

Ethics approval

The Adult AML Working Group of the JSTCT and the institutional review board of the Institute of Medical Science, The University of Tokyo (2021-30-0729) approved this retrospective study, which was conducted in accordance with the principles of the Declaration of Helsinki.

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Konuma, T., Harada, K., Kondo, T. et al. Salvage single-unit unrelated cord blood transplantation for graft failure following initial allogeneic transplantation in adult acute myeloid leukemia: trends in outcomes over the past 20 years. Bone Marrow Transplant 57, 1848–1850 (2022). https://doi.org/10.1038/s41409-022-01840-1

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  • DOI: https://doi.org/10.1038/s41409-022-01840-1

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