Journal
LEUKEMIA
Volume 31, Issue 6, Pages 1408-1414Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/leu.2017.42
Keywords
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Categories
Funding
- Public Health Service from the National Cancer Institute (NCI) [5U24-CA076518]
- National Heart, Lung and Blood Institute (NHLBI)
- National Institute of Allergy and Infectious Diseases (NIAID)
- NHLBI [5U10HL069294]
- NCI
- Health Resources and Services Administration (HRSA/DHHS) [HHSH250201200016C]
- Office of Naval Research [N00014-15-1-0848, N00014-16-1-2020]
- Alexion
- Amgen Inc
- Astellas Pharma US
- AstraZeneca
- Be the Match Foundation
- Bluebird Bio Inc.
- Bristol Myers Squibb Oncology
- Celgene Corporation
- Cellular Dynamics International Inc.
- Chimerix Inc.
- Fred Hutchinson Cancer Research Center
- Gamida Cell Ltd
- Genentech Inc.
- Genzyme Corporation
- Gilead Sciences Inc.
- Health Research Inc.
- HistoGenetics Inc.
- Incyte Corporation
- Janssen Scientific Affairs, LLC
- Jazz Pharmaceuticals Inc.
- Jeff Gordon Children's Foundation
- The Leukemia and Lymphoma Society
- Medac GmbH
- MedImmune
- Medical College of Wisconsin
- Merck Co. Inc.
- Mesoblast
- MesoScale Diagnostics Inc.
- Miltenyi Biotec Inc.
- National Marrow Donor Program
- Neovii Biotech NA Inc.
- Novartis Pharmaceuticals Corporation
- Onyx Pharmaceuticals
- Optum Healthcare Solutions Inc.
- Otsuka America Pharmaceutical Inc.
- Otsuka Pharmaceutical Co. Ltd, Japan
- PCORI
- Perkin-Elmer Inc.
- Pfizer Inc.
- Sanofi US
- Seattle Genetics
- Spectrum Pharmaceuticals Inc.
- St Baldrick's Foundation
- Sunesis Pharmaceuticals Inc.
- Swedish Orphan Biovitrum Inc.
- Takeda Oncology
- Telomere Diagnostics Inc.
- University of Minnesota
- Wellpoint Inc.
- Roswell Park Cancer Institute
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Allogeneic hematopoietic cell transplantation (HCT) from siblings or unrelated donors (URD) during complete remission (CR) may improve leukemia-free survival (LFS) in FMS-like tyrosine kinase 3+ (FLT3+) acute myeloid leukemia (AML), which has poor prognosis because of high relapse rates. Umbilical cord blood (UCB) HCT outcomes are largely unknown in this population. We found that compared with sibling HCT, relapse risks were similar after UCB (n = 126) (hazard ratio (HR) 0.86, P = 0.54) and URD (n = 91) (HR 0.81, P = 0.43). UCB HCT was associated with statistically higher non-relapse mortality compared with sibling HCT (HR 2.32, P = 0.02), but not vs URD (HR 1.72, P = 0.07). All three cohorts had statistically nonsignificant 3-year LFS: 39% (95% confidence interval (CI): 30-47) after UCB, 43% (95% CI: 30-54) after sibling and 50% (95% CI: 40-60) after URD. Chronic graft-versus-host disease rates were significantly lower after UCB compared with either sibling (HR 0.59, P = 0.03) or URD (HR 0.49, P = 0.001). Adverse factors for LFS included high leukocyte count at diagnosis and HCT during CR2 (second CR). UCB is a suitable option for adults with FLT3+ AML in the absence of an human leukocyte antigen-matched sibling and its immediate availability may be particularly important for FLT3+ AML where early relapse is common, thus allowing HCT in CR1 (first CR) when outcomes are best.
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