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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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.
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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.
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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.
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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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DOI: https://doi.org/10.1038/s41409-023-02000-9