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Haematologica February 2016 : Doi:10.3324/haematol.2015.138594
Abstract
Umbilical cord blood stem cell transplants are commonly used in adults lacking HLA-identical donors. Delays in hematopoietic recovery contribute to mortality and morbidity. To hasten recovery we used co-infusion of progenitor cells from a partially matched related donor and an UCB (haplo-cord transplant).
Here we compared the outcomes of haplo-cord and double-cord transplants. 97 adults underwent reduced intensity conditioning followed by haplo-cord transplant and 193 patients received reduced intensity conditioning followed by double umbilical cord blood transplantation. Patients in the haplo-cord group were more often from minority groups and had more advanced malignancy. Haplo-cord received fludarabine-melphalan-ATG. Double umbilical cord blood recipients received fludarabine-cyclophosphamide and low dose total body irradiation. In a multivariate analysis haplo-cord had faster neutrophil (HR = 1.42,P = 0.007) and platelet recovery (HR=2.54, P < 0.0001), lower risk of grade II-IV acute graft vs. host disease (GVHD) (HR = 0.26, P < 0.0001) and chronic GVHD (HR=0.06, P < 0.0001).
Haplo-cord was associated with decreased risk of relapse (HR 0.48, P = 0.001). Graft-versus-host disease-free, relapse-free survival was superior with haplo-cord (HR 0.63, P=0.002) but not overall survival HR=0.97 ,P = 0.85). Haplo-cord transplantation using fludarabine-melphalan-thymoglobulin conditioning hastens hematopoietic recovery with a lower risk of relapse relative to double umbilical cord blood transplantation using the commonly used fludarabine-cyclophosphamide-low dose total body irradiation conditioning. Graft-versus-host disease-free, relapse-free survival is significantly improved. Haplo-cord is a readily available graft source that improves outcomes and access to transplant for those lacking HLA matched donors. Trials registered at ClinicalTrials.gov: NCT00943800 and NCT 01810588.
LFLN REF 03052016, p.40
