Impact of detectable measurable residual disease on umbilical cord blood transplantation
- 25 May 2020
- journal article
- research article
- Published by Wiley in American Journal of Hematology
- Vol. 95 (9), 1057-1065
- https://doi.org/10.1002/ajh.25879
Abstract
The impact of measurable residual disease (MRD) on cord blood transplantation (CBT) outcomes has remained debated. To address this issue, we assessed the impact of measurable MRD at CBT on outcomes in large cohort of patients with acute leukemia. Inclusion criteria included adult patients with acute myeloid (AML) or acute lymphoblastic leukemia (ALL), CBT as first allo‐HCT in first or second complete remission (CR) at transplantation, and known MRD status at the time of CBT. Data from 506 patients were included in the analysis. Among them, 317 patients had AML and 189 had ALL. Positive MRD was reported in 169 (33%) patients while the remaining 337 patients were MRD negative at CBT. At 2 years, relapse incidence was 18% in patients with MRD negativity versus 33% in those with MRD positivity at transplantation (Pversus 38% (P<0.001) and 48% (P=0.004), respectively, in those with MRD positivity. There was no interaction between the impact of MRD on OS and LFS and diagnosis (i.e. ALL versus AML), single or double CBT, and reduced‐intensity or myeloablative conditioning. On multivariate analysis, MRD positivity was associated with a higher risk of relapse (HR=1.8, P=0.003), comparable non‐relapse mortality (P=0.44), worse LFS (HR=1.4, P=0.008) and a trend towards worse OS (HR=1.3, P=0.065). In conclusion, these data suggest that novel strategies that are aiming to achieve MRD negativity at CBT are needed for leukemic patients with positive MRD pre‐CBT.Funding Information
- Fonds De La Recherche Scientifique - FNRS (FB is senior research associate)
This publication has 44 references indexed in Scilit:
- Role of allogeneic stem cell transplantation in adult patients with Ph-negative acute lymphoblastic leukemiaBlood, 2015
- Impact of rabbit ATG-containing myeloablative conditioning regimens on the outcome of patients undergoing unrelated single-unit cord blood transplantation for hematological malignanciesBone Marrow Transplantation, 2014
- Impact of minimal residual disease on outcomes after umbilical cord blood transplantation for adults with Philadelphia-positive acute lymphoblastic leukaemia: an analysis on behalf of Eurocord, Cord Blood Committee and the Acute Leukaemia working party ofBritish Journal of Haematology, 2014
- Comparison of outcomes after single or double cord blood transplantation in adults with acute leukemia using different types of myeloablative conditioning regimen, a retrospective study on behalf of Eurocord and the Acute Leukemia Working Party of EBMTLeukemia, 2013
- Umbilical cord blood transplantation: the first 25 years and beyondBlood, 2013
- Impact of graft-versus-host disease after reduced-intensity conditioning allogeneic stem cell transplantation for acute myeloid leukemia: a report from the Acute Leukemia Working Party of the European group for blood and marrow transplantationLeukemia, 2012
- Refinement of cytogenetic classification in acute myeloid leukemia: determination of prognostic significance of rare recurring chromosomal abnormalities among 5876 younger adult patients treated in the United Kingdom Medical Research Council trialsBlood, 2010
- Relapse risk after umbilical cord blood transplantation: enhanced graft-versus-leukemia effect in recipients of 2 unitsBlood, 2009
- Transplantation of 2 partially HLA-matched umbilical cord blood units to enhance engraftment in adults with hematologic malignancyBlood, 2005
- CLINICAL MANIFESTATIONS OF GRAFT-VERSUS-HOST DISEASE IN HUMAN RECIPIENTS OF MARROW FROM HL-A-MATCHED SIBLING DONOR,STransplantation, 1974