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Blood, 15 December 2003, Vol. 102, No. 13, pp. 4290-4297.
Prepublished online as a Blood First Edition Paper on August 14, 2003; DOI 10.1182/blood-2003-04-1288.
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CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Unrelated cord blood transplantation for childhood acute myeloid leukemia: a Eurocord Group analysis
Gerard Michel,
Vanderson Rocha,
Sylvie Chevret,
William Arcese,
Kah-Wah Chan,
Alexandra Filipovich,
Tsuneo A. Takahashi,
Marcus Vowels,
Juan Ortega,
Pierre Bordigoni,
Peter J. Shaw,
Isaac Yaniv,
Alexandra Machado,
Pedro Pimentel,
Franca Fagioli,
Amparo Verdeguer,
Jean Pierre Jouet,
Blanca Diez,
Euripedes Ferreira,
Ricardo Pasquini,
Joseph Rosenthal,
Eric Sievers,
Chiara Messina,
Anna Paola Iori,
Federico Garnier,
Irina Ionescu,
Franco Locatelli, and
Eliane Gluckman, for the Eurocord Group
From the Department of Medicine, University of Marseille, Marseille, France; Eurocord office, Paris, France; Biostatistics Department, St Louis Hospital, University of Paris 7, France; Department of Hematology, University La Sapienza, Rome, Italy; MD Anderson Cancer Center, Houston, TX; Children's Hospital Medical Center, Cincinnati, OH; Tokyo Cord Blood Bank, Tokyo, Japan; Sydney Children's Hospital, Sydney, Australia; Hospital Infantil Vall d'Hebron, Barcelona, Spain; Hôpital d'Enfants, Nancy, France; The New Children's Hospital, Sydney, Australia; Schneider Children's Hospital, Petach-Tikva, Israel; Inst Portugues de Oncologia, Lisboa, Portugal; Inst Portugues de Oncologia, Porto, Portugal; Ospedale Regine Margherita, Torino, Italy; Hospital Infantil La Fe, Valencia, Spain; Claude Huriez Hospital, Lille, France; Fleni, Buenos Aires, Argentina; Hospital Israelita Albert Einstein, Sao Paulo, Brazil; Hospital de Clinicas, Curitiba, Brazil; City of Hope Medical School, Duarte, CA; Fred Hutchinson Cancer Research Center (FHCRC), Seattle, WA; Clinica Oncoematologica Pediatrica, Padova, Italy; Oncoematologia Pediatrica, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy.
Results of unrelated cord blood transplantation (UCBT) in childhood acute myeloid leukemia (AML) have not been previously reported. We analyzed 95 children receiving UCB transplants for AML (20 in first complete remission [CR1], 47 in CR2, and 28 in more advanced stage). Poor prognosis cytogenetic abnormalities were identified in 29 cases. Most patients received a 1 or 2 HLA antigens-mismatched UCB transplants. The median number of collected nucleated cells (NCs) was 5.2 x 107/kg. Cumulative incidence (CI) of neutrophil recovery was 78% ± 4%, acute graft-versus-host disease (GVHD) was 35% ± 5%, and 100-day transplantation-related mortality (TRM) was 20% ± 4%. In multivariable analysis, a collected NC dose higher than 5.2 x 107/kg was associated with a lower 100-day TRM. The 2-year CI of relapse was 29% ± 5% and was associated with disease status. The 2-year leukemia-free survival (LFS) was 42% ± 5% (59% ± 11% in CR1, 50% ± 8% in CR2, and 21% ± 9% for children not in CR). Children with poor prognosis cytogenetic features had similar LFS compared with other patients (44% ± 11% vs 40% ± 8%). In CR2, LFS was not influenced by the length of CR1 (53% ± 11% in CR1 < 9.5 months compared with 50% ± 12% in later relapses). We conclude that UCBT is a therapeutic option for children with very poor-prognosis AML and who lack an HLA-identical sibling. (Blood. 2003;102:4290-4297)
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