Clinical Research Papers:
Transplants of unrelated cord blood or sibling allogeneic peripheral blood stem cells/bone marrow in adolescent and young adults with chronic myeloid leukemia: comparable outcomes but better chronic GVHD-free and relapse-free survival among survivors with cord blood
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Changcheng Zheng1, Xiaoyu Zhu1, Baolin Tang1, Xuhan Zhang1, Lei Zhang1, Liangquan Geng1, Huilan Liu1 and Zimin Sun1
1Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China
Zimin Sun, email: [email protected]
Keywords: chronic myeloid leukemia; cord blood transplantation; chronic GVHD; GVHD/relapse-free survival; adolescent and young adult
Received: March 22, 2017 Accepted: November 14, 2017 Published: December 05, 2017
Adolescent and young adult (AYA) patients with hematological malignancy aged 15 to 39 years are recognized as a separate entity, and the efficacy and safety of unrelated cord blood transplantation (CBT) for chronic myeloid leukemia (CML) in AYA patients has not been reported. From March 2002 to June 2015, total of 106 CML patients received allogeneic hematopoietic cell transplantation (allo-HCT) in our center. Included in the present study were CML patients aged 15 to 39 years who received unrelated CBT or sibling allo-HCT, and 74 consecutive AYA patients with CML enrolled in this analysis. The day-100 cumulative incidences of grade 2–4 aGVHD and grade 3–4 aGVHD were similar following CBT and sibling-PBSCT/BMT. The cumulative incidences of cGVHD and extensive cGVHD were 21.7% and 5.3% in the CBT cohort, which were significantly lower than those in the sibling-PBSCT/BMT cohort (58.0% and 45.5%), respectively (p = 0.046, 0.008). There was no significant difference between the two cohorts in terms of transplant-related mortality (TRM), relapse, and long-term survival (overall survival and leukemia-free survival). The 5-year probability of GVHD-free/relapse-free survival (GRFS) was 47.9% and 33.4% in the CBT and the sibling-PBSCT/BMT cohorts, respectively (p = 0.632); among patients who survived more than 100 days after transplantation (n = 61), the 5-year probability of chronic GVHD-free, relapse-free survival (CRFS) was 66.2% in the CBT cohort, which was significantly higher than that in the sibling-PBSCT/BMT cohort (37.4%) (p = 0.037). Our study suggests that for AYA patients with CML, transplantation using unrelated CB offers comparable outcomes to sibling -PBSCT/BMT, including similar aGVHD, TRM, relapse, and long-term survival; however, from the perspective of quality of life, unrelated CBT have a lower incidence of cGVHD and a higher CRFS among survivors.
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