RIC versus MAC UCBT in adults with AML: A report from Eurocord, the ALWP and the CTIWP of the EBMT

// Frédéric Baron 1,* , Annalisa Ruggeri 2,3,* , Eric Beohou 4 , Myriam Labopin 4 , Guillermo Sanz 5 , Noel Milpied 6,7 Mauricette Michallet 8 , Andrea Bacigalupo 9 , Didier Blaise 10 , Jorge Sierra 11 , Gérard Socié 12 , Jan J. Cornelissen 13 , Christoph Schmid 14 , Sebastian Giebel 15 , Norbert-Claude Gorin 3,4 , Jordi Esteve 16 , Fabio Ciceri 17 , Bipin N. Savani 18 , Mohamad Mohty 3,19,20 , Eliane Gluckman 21 and Arnon Nagler 4,22 1 University of Liege, Liege, Belgium 2 Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France 3 AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France 4 EBMT Paris Office, Hospital Saint Antoine, Paris, France 5 Hospital Universitario La Fe, Servicio de Hematologia, Valencia, Spain 6 CHU Bordeaux, Hématologie Clinique et Thérapie Cellulaire-Hôpital Haut-leveque, Bordeaux, France 7 University of Bordeaux, Bordeaux, France 8 Service d’ Hematologie du Centre Hospitalier de Lyon Sud, Pierre-Bénite, France 9 Ospedale San Martino, Department of Haematology II, Genova, Italy 10 Institut Paoli Calmettes (IPC), Aix Marseille University (AMU), UM105, Centre de Recherche en Cancerologie (CRCM), Inserm U1068, CNRS UMR7258 Marseille, Marseille, France 11 Hospital Santa Creu i Sant Pau, Hematology Department, Barcelona, Spain 12 AP-HP, Hematology Transplantation, Hospital Saint-Louis, Paris, France 13 Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands 14 Klinikum Augsburg, Department of Hematology and Oncology, University of Munich, Augsburg, Germany 15 Maria Sklodowska-Curie Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland 16 Deptartment of Hematology, Hospital Clinic, Barcelona, Spain 17 Department of Hematology, Ospedale San Raffaele, Università degli Studi, Milano, Italy 18 Long Term Transplant Clinic, Vanderbilt University Medical Center, Nashville, TN, USA 19 Universite Pierre & Marie Curie, Paris, France 20 INSERM, UMRS 938, Paris, France 21 Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, France Monacord, Centre Scientifique de Monaco, Monaco 22 Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel * These authors have contributed equally to the paper Correspondence to: Frédéric Baron, email: // Keywords : unrelated cord blood, AML, reduced-intensity, myeloablative, transplantation Received : May 02, 2016 Accepted : May 14, 2016 Published : May 26, 2016 Abstract Nonrelapse mortality (NRM) is the first cause of treatment failure after unrelated cord blood transplantation (UCBT) following myeloablative conditioning (MAC). In the last decade, reduced-intensity conditioning (RIC) regimens have been developed with the aim of reducing NRM and allowing older patients and those with medical comorbidities to benefit from UCBT. The aim of the current retrospective study was to compare transplantation outcomes of acute myeloid leukemia (AML) patients given UCBT after either RIC or MAC. Data from 894 adults with AML receiving a single or double UCBT as first allograft from 2004 to 2013 at EBMT centers were included in this study. 415 patients were given UCBT after RIC while 479 patients following a MAC. In comparison to MAC recipients, RIC recipients had a similar incidence of neutrophil engraftment and of acute and chronic graft-versus-host disease (GVHD). However, RIC recipients had a higher incidence of disease relapse and a lower NRM, translating to comparable leukemia-free (LFS), GVHD-free, relapse-free survival (GRFS) and overall survival (OS). These observations remained qualitatively similar after adjusting for differences between groups in multivariate analyses. In conclusion, these data suggest that LFS and OS are similar with RIC or with MAC in adults AML patients transplanted with UCBT. These observations could serve as basis for a future prospective randomized study.