Unrelated bone marrow transplantation or immediate umbilical cord blood transplantation for patients with acute myeloid leukemia in first complete remission

• Published in: European journal of haematology 2016-09, Vol.97 (3), p.278-287
• Main Authors: Yanada, Masamitsu, Kanda, Junya, Ohtake, Shigeki, Fukuda, Takahiro, Sakamaki, Hisashi, Miyamura, Koichi, Miyawaki, Shuichi, Uchida, Naoyuki, Maeda, Tomoya, Nagamura-Inoue, Tokiko, Asou, Norio, Morishima, Yasuo, Atsuta, Yoshiko, Miyazaki, Yasushi, Kimura, Fumihiko, Kobayashi, Yukio, Takami, Akiyoshi, Naoe, Tomoki, Kanda, Yoshinobu
• Format: Article
• Language: English
• Subjects: acute myeloid leukemia; Adolescent; Adult; Bone Marrow Transplantation - methods; Clinical Decision-Making; Clinical Trials, Phase III as Topic; Cord Blood Stem Cell Transplantation - methods; decision analysis; Female; first complete remission; Humans; Leukemia, Myeloid, Acute - diagnosis; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - therapy; Male; Middle Aged; Quality of Life; Remission Induction; Tissue Donors; Transplantation, Homologous; Treatment Outcome; umbilical cord blood transplantation; unrelated bone marrow transplantation; Young Adult
• ISSN: 0902-4441; 1600-0609
• DOI: 10.1111/ejh.12723

Background While unrelated bone marrow transplantation (UBMT) has been widely used as alternative donor transplantation, the use of umbilical cord blood transplantation (UCBT) is increasing recently. Methods We conducted a decision analysis to address which transplantation procedure should be prioritized for younger patients with acute myeloid leukemia (AML) harboring high‐ or intermediate‐risk cytogenetics in first complete remission (CR1), when they lack a matched related donor but have immediate access to a suitable umbilical cord blood unit. Main sources for our analysis comprised the data from three phase III trials for a chemotherapy cohort (n = 907) and the registry data for a transplantation cohort (n = 752). Results The baseline analysis showed that when the 8/8 match was considered for UBMT, the expected 5‐year survival rate was higher for UBMT than for UCBT (58.1% vs. 51.8%). This ranking did not change even when the 7/8 match was considered for UBMT. Sensitivity analysis showed consistent superiority of UBMT over UCBT when the time elapsed between CR1 and UBMT was varied within a plausible range of 3–9 months. Conclusions These results suggest that 8/8 or 7/8 UBMT is a better transplantation option than UCBT even after allowing time required for donor coordination.