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Article Dans Une Revue Blood Année : 2016

Single- vs double-unit cord blood transplantation for children and young ă adults with acute leukemia or myelodysplastic syndrome

Anne Sirvent
  • Fonction : Auteur
Cécile Pochon
Bénédicte Bruno
  • Fonction : Auteur
Charlotte Jubert
  • Fonction : Auteur
Anderson Loundou
Aude Marie-Cardine
  • Fonction : Auteur
Didier Blaise
Cecile Renard
  • Fonction : Auteur
Jean-Hugues Dalle

Résumé

Transplantation of 2 unrelated cord blood (UCB) units instead of 1 has been proposed to increase the cell dose. We report a prospective randomized study, designed to compare single- vs double-UCB transplantation in children and young adults with acute leukemia in remission or myelodysplasia. Eligible patients had at least two 4-6 HLA-identical UCBs with >3 × 10(7) nucleated cells/kg for the first and >1.5 × 10(7) for the second. The primary end point was the 2-year cumulative incidence of transplantation strategy failure, a composite end point including transplant-related mortality (TRM), engraftment failure, and autologous recovery. Randomized patients who did not proceed to transplantation due to refractory disease were considered transplantation failures. A total of 151 patients were randomized and included in the intent-to-treat analysis; 137 were transplanted. Double-UCB transplantation did not decrease transplantation strategy failure (23.4% ± 4.9% vs 14.9% ± 4.2%). Two-year posttransplant survival, disease-free survival, and TRM were 68.8% ± 6.0%, 67.6% ± 6.0%, and 5.9% ± 2.9% after single-unit transplantation compared with 74.8% ± 5.5%, 68.1% ± 6.0%, and 11.6% ± 3.9% after double-unit transplantation. The final relapse risk did not significantly differ, but relapses were delayed after double-unit transplantation. Overall incidences of graft-versus-host disease (GVHD) were similar, but chronic GVHD was more frequently extensive after double-UCB transplantation (31.9% ± 5.7% vs 14.7% ± 4.3%, P = .02). In an exploratory subgroup analysis, we found a significantly lower relapse risk after double-unit transplantation in patients receiving total body irradiation without antithymocyte globulin (ATG), whereas the relapse risk was similar in the group treated with busulfan, cyclophosphamide, and ATG. Single-UCB transplantation with adequate cell dose remains the standard of care and leads to low TRM. Double-unit transplantation should be reserved for patients who lack such units. This trial was registered at www.clinicaltrials.gov as #NCT01067300.

Dates et versions

hal-01482531 , version 1 (03-03-2017)

Identifiants

Citer

Gerard Michel, Claire Galambrun, Anne Sirvent, Cécile Pochon, Bénédicte Bruno, et al.. Single- vs double-unit cord blood transplantation for children and young ă adults with acute leukemia or myelodysplastic syndrome. Blood, 2016, 127 (26), pp.3450-3457. ⟨10.1182/blood-2016-01-694349⟩. ⟨hal-01482531⟩
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