IACH 2021 | Cord blood vs mismatched unrelated donor alloHCT in AML
Bhagirathbhai Dholaria, MBBS, of Vanderbilt University Medical Center, Nashville, TN, gives an update on the use of cord blood transplantation (CBT) versus mismatched unrelated donor (MMUD) allogenic hematopoietic cell transplantation (alloHCT) for patients with acute myeloid leukemia (AML) who do not have a human leukocyte antigen (HLA)-matched donor. Dr Dholaria outlines a study which reported that MMUD is the preferable method to CBT, as CBT was associated with lower leukemia-free survival (LFS), overall survival (OS), and GvHD-free relapse-free survival (GRFS), due to a higher non-relapse mortality. This interview took place at the 4th Annual Meeting of the International Academy for Clinical Hematology (IACH), which took place virtually in 2021.
Transcript (edited for clarity)
This is an important question in the field right now because for the patients who lack a fully HLM-matched donor, the options currently as of 2021 are cord blood transplantation using a partially HLM-matched related or unrelated donor, and we’ve been using post-transplant cyclophosphamide in this setting and which has made this procedure extremely safe and effective.
So, in a study, we embarked on asking these questions using Acute Leukemia Working Party database, looked at AML patients who underwent mismatched unrelated donor stem cell transplantation with post-transplant cyclophosphamide and compared their outcome to patients with AML who underwent a cord blood transplantation...
This is an important question in the field right now because for the patients who lack a fully HLM-matched donor, the options currently as of 2021 are cord blood transplantation using a partially HLM-matched related or unrelated donor, and we’ve been using post-transplant cyclophosphamide in this setting and which has made this procedure extremely safe and effective.
So, in a study, we embarked on asking these questions using Acute Leukemia Working Party database, looked at AML patients who underwent mismatched unrelated donor stem cell transplantation with post-transplant cyclophosphamide and compared their outcome to patients with AML who underwent a cord blood transplantation.
When we looked at in a multivariate analysis, patients who received core blood stem cell transplantation for AML had a higher risk of non-relapse mortality and relapse risk which led to worse leukemia-free overall survival compared to mismatched unrelated donor transplant to CPN with a post-transplant cyclophosphamide. There was also higher incidence of graft failure, not surprisingly, in the recipient of cord blood transplantation compared to a mismatch unrelated donor transplantation.
So, this study also shows that at least in this retrospective comparison, our outcomes are superior in individuals with AML who went in a mismatched-unrelated donor transplantation with a post-transplant cyclophosphamide compared to cord blood transplantation.
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Disclosures
Bhagirathbhai Dholaria, MBBS, has received research or grant support from Janssen, Takeda, MEI, Poseida, Angiocrine and Pfizer; and has received consultation/advisory board/employment fees from Jazz Pharmaceuticals.
