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Cord blood is a suitable donor source of allogeneic hematopoietic cell transplantation for adult T-cell leukemia-lymphoma: a nationwide retrospective study

Bone Marrow Transplantation volume 58, pages 462–464 (2023)Cite this article

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Although allogeneic hematopoietic cell transplantation (allo-HCT) is a curative treatment for aggressive-type adult T-cell leukemia-lymphoma (ATL) [1, 2], it has been reported that cord blood transplantation (CBT) for ATL is associated with significantly worse prognosis compared with other donor sources [3,4,5]. CBT for ATL has been routinely implemented in Japan as ATL requires rapid HCT and the efficacy of CBT has recently improved [6]. Therefore, we retrospectively re-evaluated CBT for ATL from a nationwide Japanese database, the Japan Society for Transplantation and Cellular Therapy (JSTCT) using the Transplant Registry Unified Management Program [7]. We collected data from the largest cohort on patients with ATL who received first allo-HCT between 2008 and 2017. The study was approved by the JSTCT data management committees and Imamura General Hospital Institutional Review Board. All CBT recipients received a single unit. Overall survival (OS) was calculated from the time of HCT until death or the last follow-up. The cause of death was categorized as either ATL-related mortality (ATL-RM) or transplantation-related mortality (TRM). TRM was defined as any death other than ATL-RM. Patients who remained alive at the time of the last follow-up were censored. Descriptive statistics were used to summarize the variables related to the patients and HCT characteristics. A propensity score-matched (PSM) analysis was performed to minimize treatment selection bias and eliminate confounding bias between the patients who received CBT (CBT group) and the patients who received HCT from other donor sources (non-CBT group). Logistic regression was used for the propensity score calculation from the following variables that were relevant to earlier research findings: age, sex, clinical subtype, performance status (PS), hematopoietic cell transplantation-specific comorbidity index (HCT-CI), disease status, the interval from initial diagnosis to HCT, ABO matching, sex combination between recipient and donor, conditioning regimen, and GVHD prophylaxis. A 1:1 matched study group was created with the use of the nearest approach. All statistical analyses were performed using EZR Version 1.52 software (Saitama Medical Center, Jichi Medical University, Saitama, Japan), a graphical user interface for R 4.0.0 (R Foundation for Statistical Computing) [8].

From 2008–2017, 446 patients with ATL received CBT in Japan, and we compared the characteristics and HCT outcomes of patients between 2008–2012 and 2013–2017 (Supplementary Table 1). The median age at HCT in 2013–2017 was 3 years older than in 2008–2012 (61 vs 58 years, range: 31–78 vs 24–72, respectively; P < 0.001). There were significantly more patients in 2013–2017, with complete remission (CR) at HCT (44.3% vs. 23.7%; P < 0.001), with anti-HLA antibody testing before cord blood unit selection, (97.9% vs. 65.2%; P < 0.001), receiving reduced-intensity conditioning regimen (P = 0.028), tacrolimus for GVHD prophylaxis (P < 0.001), and concomitant mycophenolate mofetil for GVHD prophylaxis (52.1% vs. 34.7%; P < 0.001) than in 2008–2012. In the CBT group (Supplementary Fig. 1A), the median period from HCT to neutrophil engraftment (NE) (20 days, 95% confidence interval [CI]: 19–21 days) and the cumulative incidence of NE in 2013–2017 (day 50 post-allo-HCT: 87.3%, 95% CI: 82.9–90.6%) was improved compared to those in 2008–2012 (21 days, 95% CI: 19–21 days and 79.4%, 95% CI: 72.1–84.9%; P = 0.042).

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Fig. 1: Transplantation outcoms after propensity score-matched analyses.

Data availability

The data of this study are not publicly available ethical restrictions that it exceeds the scope of the recipient/donor’s consent for research use in the registry. Data may be available from the corresponding author upon reasonable request and with permission of the JSTCT and the Japanese Data Center for Hematopoietic Cell Transplantation.

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Acknowledgements

We thank all the physicians and data managers at the institutions that contributed valuable data on HCT for ATL at JSTCT. We also thank all the members of the data management committees of the JSTCT. We thank Editage (www.editage.com) for English language editing. This work was supported, in part, by Practical Research Programs of the Japan Agency for Medical Research and Development (AMED) (22ck0106742h0001).

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Authors and Affiliations

  1. Department of Hematology, Imamura General Hospital, Kagoshima, Japan

    Masahito Tokunaga, Nobuaki Nakano & Atae Utsunomiya

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

    Shigeo Fuji

  3. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations TORANOMON HOSPITAL KAJIGAYA, Tokyo, Japan

    Atsushi Wake

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

    Ayumu Ito & Takahiro Fukuda

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

    Tetsuya Eto

  6. Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan

    Toshiro Kawakita

  7. Hematology, Oncology & Cardiovascular medicine, Kyushu University Hospital, Fukuoka, Japan

    Yasuo Mori & Koji Kato

  8. Department of Hematology, Sasebo City General Hospital, Nagasaki, Japan

    Yukiyoshi Moriuchi

  9. Department of Hematology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

    Youko Suehiro

  10. Department of Hematology, Oita Prefectural Hospital, Oita, Japan

    Yasuhiko Miyazaki

  11. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations TORANOMON HOSPITAL, Tokyo, Japan

    Naoyuki Uchida

  12. Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan

    Yasushi Sawayama

  13. Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima, Japan

    Kenji Ishitsuka & Makoto Yoshimitsu

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

    Junya Kanda

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

    Takafumi Kimura

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

    Tatsuo Ichinohe

  17. Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan

    Yoshiko Atsuta

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

    Yoshiko Atsuta

Authors
  1. Masahito Tokunaga
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Contributions

MT, NN, SF, AW, AU, TF, MY, and KK participated in research design, data analyses, and writing of the paper. AI, TE, Toshio K, Yoshio M, Yukiyoshi M, Youko S, Yasuhiko M, NU, Yasushi S and KI participated in data collection and writing of the paper. JK, Takafumi K, TI, and YA participated in data management and writing of the paper.

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Correspondence to Masahito Tokunaga.

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Tokunaga, M., Nakano, N., Fuji, S. et al. Cord blood is a suitable donor source of allogeneic hematopoietic cell transplantation for adult T-cell leukemia-lymphoma: a nationwide retrospective study. Bone Marrow Transplant 58, 462–464 (2023). https://doi.org/10.1038/s41409-023-01919-3

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  • DOI: https://doi.org/10.1038/s41409-023-01919-3

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