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Outcomes of graft failure after umbilical cord blood transplantation in acute leukemia: a study from Eurocord and the Acute Leukemia Working Party of the EBMT

Bone Marrow Transplantation volume 58, pages 936–941 (2023)Cite this article

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Abstract

Graft failure has remained a limitation of umbilical cord blood transplantation (CBT). Here, we assessed the outcomes of patients who experienced graft failure after CBT. Inclusion criteria were patients (age ≥ 18 years) experiencing graft failure after unrelated CBT (single or double) between 2005 and 2016, for acute myelogenous leukemia (AML) or acute lymphoblastic leukemia (ALL), no prior allogeneic or autologous transplantation, no other stem cell product. The study included 87 patients. At 1-year, cumulative incidence of relapse and nonrelapse mortality (NRM) was 35% and 37%, respectively. One-year overall survival (OS) and progression-free survival (PFS) was 40% and 29%, respectively. Forty-six patients underwent a salvage second transplantation with 1-year and 2-year OS and PFS from second transplantation 41% and 34% for OS, and 37% and 34% for PFS, respectively. In multivariate analysis, complete remission (CR) at CBT (HR = 0.45, 95% CI 0.25–0.83, P = 0.01) and reduced-intensity conditioning (HR = 0.51, 95% CI 0.29–0.91, P = 0.023) were associated with better OS. In conclusion, in this retrospective study, we observed that approximately one-quarter of patients experiencing graft failure after CBT remained alive without relapse 2 years later.

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Fig. 1: Outcomes of patients with graft failure after CBT.
Fig. 2: Incidence of second transplantation.
Fig. 3: Outcomes of patients with salvage second transplantation as treatment for graft failure after CBT.

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Data availability

CP, ML, MMo and AN had full access to all the data in the study (available upon data specific request).

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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.

Author information

Author notes

  1. These authors contributed equally: Frédéric Baron, Annalisa Ruggeri.

Authors and Affiliations

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

    Frédéric Baron

  2. Eurocord, Saint Louis Hospital, Paris, France and Centre scientifique de Monaco, Paris, Monaco

    Annalisa Ruggeri & Eliane Gluckman

  3. IRCCS San Raffaele Scientific Institute,department of Hematologogy and BMT, Milano, Italy

    Annalisa Ruggeri

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

    Christophe Peczynski, Myriam Labopin & Mohamad Mohty

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

    Christophe Peczynski, Myriam Labopin & Mohamad Mohty

  6. INSERM UMR 938, Paris, France

    Christophe Peczynski, Myriam Labopin & Mohamad Mohty

  7. Sorbonne university, Paris, France

    Christophe Peczynski, Myriam Labopin & Mohamad Mohty

  8. Gustave Roussy, institut de cancérologie, BMT Service, Division of Hematology, Villejuif, France

    Jean-Henri Bourhis

  9. Service d’Hématologie du Centre de lutte contre le Cancer Léon Bérard, Lyon, France

    Mauricette Michallet

  10. CHU Nantes, Dept. D’Hematologie, Nantes, France

    Patrice Chevallier

  11. University Hospital La Fe, Hematology Department, Valencia, Spain

    Jaime Sanz

  12. Service d’Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, F-33000, Bordeaux, France

    Edouard Forcade

  13. Azienda Ospedaliera Universitaria Careggi, Cell Therapy and Transfusion Medicine Unit, Firenze, Italy

    Riccardo Saccardi

  14. Kings College Hospital, London, UK

    Victoria Potter

  15. Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel and the EBMT Paris Office, Hospital Saint Antoine, Paris, France

    Arnon Nagler

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  1. Frédéric Baron
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Contributions

FB wrote the manuscript, designed the study, and interpreted the data. CP and ML designed the study, performed the statistical analyses, interpreted the data, and edited the manuscript. AR, EG, MMo and AN designed the study, interpreted the data, and edited the manuscript. JS, RS, CP, MMi, JHB, CF and WA reviewed the manuscript and provided clinical data. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Frédéric Baron.

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Competing interests

FB has received travel grants and/or speaker honoraria from Celgene, Abbvie, Novartis, Pfizer and Sanofi. The other authors declare that they have no relevant conflict of interest.

Ethics approval and consent to participate

The scientific boards of the ALWP of the EBMT approved this study. The study was conducted according to the Declaration of Helsinki and Good Clinical Practice guidelines.

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Baron, F., Ruggeri, A., Peczynski, C. et al. Outcomes of graft failure after umbilical cord blood transplantation in acute leukemia: a study from Eurocord and the Acute Leukemia Working Party of the EBMT. Bone Marrow Transplant 58, 936–941 (2023). https://doi.org/10.1038/s41409-023-02000-9

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