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Umbilical cord blood (UCB) is an ideal source of grafts in many aspects due to the less stringent requirements for HLA matching, faster graft acquisition and good anti-tumor effect
.
However, its use has been limited in the past by slow engraftment and high early transplant-related mortality (TRM) rates
.
British C.
Anthias et al conducted a related study to explore the safety and efficacy of different conditioning regimens combined with umbilical cord blood transplantation (UCBT) in the treatment of hematological malignancies
.
The study was selected for the poster presentation of the 48th European Society of Blood and Marrow Transplantation (EBMT) annual meeting this year.
The editor will organize the main contents as follows for readers' reference
.
Methods We performed a retrospective single-center analysis to determine the outcomes of UCBT in 81 adult patients with hematologic malignancies from 1/1/2005 to 1/11/2020
.
Data from 10 additional patients transplanted between 1/11/2020 and 1/8/2021 were included in the analysis of engraftment and acute graft-versus-host disease (aGVHD)
.
Results The median age of patients at the time of transplantation was 43 years (range: 18-70 years)
.
46 patients had acute myeloid leukemia (AML), 16 had acute lymphoblastic leukemia (ALL), 5 had myelodysplastic syndrome (MDS), 10 had lymphoma, and 3 had myeloproliferative disease (MPD).
), and one case was multiple myeloma (MM)
.
Forty-five patients received a reduced-intensity conditioning (RIC) regimen (fludarabine/cyclophosphamide/2Gy TBI), and 32 patients received a myeloablative conditioning (MAC) regimen (fludarabine/cyclophosphamide).
/14.
4Gy TBI), 4 patients received "Midi" conditioning regimen (fludarabine/cyclophosphamide/thiotepa/4Gy TBI)
.
The median age of the MAC and RIC groups was 29.
5 and 52.
5 years, respectively
.
Prophylactic regimens for GVHD included cyclosporine and mycophenolate mofetil, and 2 patients received antithymocyte globulin (ATG)
.
The median patient weight was 75kg (range: 47-139kg)
.
Twenty-nine patients received a single UCBT and 62 received a double UCBT
.
The median cord blood total nucleated cells (TNC) per patient before thawing was 4.
39 (range: 2.
0-7.
13) x 107/kg, and the median CD34+ cell dose per patient was 2.
35 (range: 0.
12- 6.
32) x105/kg
.
All patients received HLA-mismatched cord blood
.
In the entire cohort, the median time to neutrophil engraftment was 20 days (22 days before 2017, 18 days in 2017-2021, p=0.
19)
.
Implantation was delayed in 3 patients and failed in 5 patients (5.
4%)
.
Among 81 patients eligible for survival analysis, median follow-up was 24 months (range: 12-135 months)
.
The 2- and 5-year OS rates were 59.
8% and 53.
1%, respectively, and patients with the MAC conditioning regimen had a higher OS rate compared with the RIC conditioning regimen (5-year OS rate: 72.
9% vs 40.
0%, p=0.
02 )
.
This was due to a reduction in recurrence in the MAC group (5-year recurrence rate: 8.
5% vs 26.
3%; p=0.
035), whereas NRM did not differ (2-year NRM rate: 18.
2% vs 30.
6%; p=0.
18)
.
The 5-year OS rate in patients ≥60 years was comparable to younger patients (50.
4% vs 53.
9%; p=0.
71), and there was no survival difference in MRD-positive acute leukemia compared with minimal residual disease (MRD)-negative patients (52% vs 60%) % p=0.
88)
.
The incidence of grade I-IV and grade III-IV aGVHD in patients still alive at 100 days was 53% and 13%, respectively
.
The incidence of chronic graft-versus-host disease (cGVHD) and severe cGVHD in patients alive at 1 year was 12% and 4.
6%, respectively
.
Study Conclusions The study data demonstrate that optimal CBU selection yields high engraftment rates with comparable or better OS than many matched donor analyses, and importantly, very low rates of severe cGVHD
.
Patients preconditioned with the MAC regimen had a better survival benefit, and where possible, increasing the intensity of RIC in healthy older patients using the "Midi" conditioning regimen may further improve outcomes
.
In addition, in the context of the COVID19 pandemic, safe and fast CBU donation channels should also be provided
.
References: C.
Anthias, S.
Easdale, I.
Evseeva, et al.
OPTIMAL CORD BLOOD UNIT SELECTION RESULTS IN GOOD ENGRAFTMENT AND LOW TRM AND RELAPSE, BUT CONDITIONING INTENSITY MATTERS.
The 48th Annual Meeting of the EBMT.
Abstract P166.
Edited : Quinta Typesetting: Quinta Execution: Quinta pokes "read the original text", we make progress together
.
However, its use has been limited in the past by slow engraftment and high early transplant-related mortality (TRM) rates
.
British C.
Anthias et al conducted a related study to explore the safety and efficacy of different conditioning regimens combined with umbilical cord blood transplantation (UCBT) in the treatment of hematological malignancies
.
The study was selected for the poster presentation of the 48th European Society of Blood and Marrow Transplantation (EBMT) annual meeting this year.
The editor will organize the main contents as follows for readers' reference
.
Methods We performed a retrospective single-center analysis to determine the outcomes of UCBT in 81 adult patients with hematologic malignancies from 1/1/2005 to 1/11/2020
.
Data from 10 additional patients transplanted between 1/11/2020 and 1/8/2021 were included in the analysis of engraftment and acute graft-versus-host disease (aGVHD)
.
Results The median age of patients at the time of transplantation was 43 years (range: 18-70 years)
.
46 patients had acute myeloid leukemia (AML), 16 had acute lymphoblastic leukemia (ALL), 5 had myelodysplastic syndrome (MDS), 10 had lymphoma, and 3 had myeloproliferative disease (MPD).
), and one case was multiple myeloma (MM)
.
Forty-five patients received a reduced-intensity conditioning (RIC) regimen (fludarabine/cyclophosphamide/2Gy TBI), and 32 patients received a myeloablative conditioning (MAC) regimen (fludarabine/cyclophosphamide).
/14.
4Gy TBI), 4 patients received "Midi" conditioning regimen (fludarabine/cyclophosphamide/thiotepa/4Gy TBI)
.
The median age of the MAC and RIC groups was 29.
5 and 52.
5 years, respectively
.
Prophylactic regimens for GVHD included cyclosporine and mycophenolate mofetil, and 2 patients received antithymocyte globulin (ATG)
.
The median patient weight was 75kg (range: 47-139kg)
.
Twenty-nine patients received a single UCBT and 62 received a double UCBT
.
The median cord blood total nucleated cells (TNC) per patient before thawing was 4.
39 (range: 2.
0-7.
13) x 107/kg, and the median CD34+ cell dose per patient was 2.
35 (range: 0.
12- 6.
32) x105/kg
.
All patients received HLA-mismatched cord blood
.
In the entire cohort, the median time to neutrophil engraftment was 20 days (22 days before 2017, 18 days in 2017-2021, p=0.
19)
.
Implantation was delayed in 3 patients and failed in 5 patients (5.
4%)
.
Among 81 patients eligible for survival analysis, median follow-up was 24 months (range: 12-135 months)
.
The 2- and 5-year OS rates were 59.
8% and 53.
1%, respectively, and patients with the MAC conditioning regimen had a higher OS rate compared with the RIC conditioning regimen (5-year OS rate: 72.
9% vs 40.
0%, p=0.
02 )
.
This was due to a reduction in recurrence in the MAC group (5-year recurrence rate: 8.
5% vs 26.
3%; p=0.
035), whereas NRM did not differ (2-year NRM rate: 18.
2% vs 30.
6%; p=0.
18)
.
The 5-year OS rate in patients ≥60 years was comparable to younger patients (50.
4% vs 53.
9%; p=0.
71), and there was no survival difference in MRD-positive acute leukemia compared with minimal residual disease (MRD)-negative patients (52% vs 60%) % p=0.
88)
.
The incidence of grade I-IV and grade III-IV aGVHD in patients still alive at 100 days was 53% and 13%, respectively
.
The incidence of chronic graft-versus-host disease (cGVHD) and severe cGVHD in patients alive at 1 year was 12% and 4.
6%, respectively
.
Study Conclusions The study data demonstrate that optimal CBU selection yields high engraftment rates with comparable or better OS than many matched donor analyses, and importantly, very low rates of severe cGVHD
.
Patients preconditioned with the MAC regimen had a better survival benefit, and where possible, increasing the intensity of RIC in healthy older patients using the "Midi" conditioning regimen may further improve outcomes
.
In addition, in the context of the COVID19 pandemic, safe and fast CBU donation channels should also be provided
.
References: C.
Anthias, S.
Easdale, I.
Evseeva, et al.
OPTIMAL CORD BLOOD UNIT SELECTION RESULTS IN GOOD ENGRAFTMENT AND LOW TRM AND RELAPSE, BUT CONDITIONING INTENSITY MATTERS.
The 48th Annual Meeting of the EBMT.
Abstract P166.
Edited : Quinta Typesetting: Quinta Execution: Quinta pokes "read the original text", we make progress together