A decision analysis comparing unrelated bone marrow transplantation and cord blood transplantation in patients with aggressive adult T-cell leukemia-lymphoma

• Published in: International journal of hematology 2020-03, Vol.111 (3), p.427-433
• Main Authors: Fuji, Shigeo, Kurosawa, Saiko, Inamoto, Yoshihiro, Murata, Tatsunori, Utsunomiya, Atae, Uchimaru, Kaoru, Yamasaki, Satoshi, Inoue, Yoshitaka, Moriuchi, Yukiyoshi, Choi, Ilseung, Ogata, Masao, Hidaka, Michihiro, Yamaguchi, Takuhiro, Fukuda, Takahiro
• Format: Article
• Language: English
• Subjects: Adult; Aged; Allografts; Blood; Bone marrow; Bone Marrow Transplantation; Chemotherapy; Computer simulation; Cord blood; Decision analysis; Decision Support Techniques; Disease Progression; Female; Fetal Blood - transplantation; Hematology; Hematopoietic stem cells; Histocompatibility antigen HLA; Humans; Leukemia; Leukemia-Lymphoma, Adult T-Cell - therapy; Life expectancy; Life span; Lymphocytes T; Lymphoma; Male; Medicine; Medicine & Public Health; Middle Aged; Monte Carlo simulation; Oncology; Original Article; Prognosis; Risk; Risk groups; Stem cell transplantation; Stem cells; Transplantation; Transplants & implants
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-019-02777-w

Patients with aggressive adult T-cell leukemia-lymphoma (ATL) have dismal outcomes with intensive chemotherapy. Early up-front allogeneic hematopoietic stem cell transplantation (allo-HSCT) is generally recommended. However, the choice of stem cell source, i.e., unrelated bone marrow transplant (UBMT) or cord blood transplantation (CBT), when an HLA-matched related donor is unavailable remains controversial. Thus, we undertook a decision analysis to compare the outcomes of two therapeutic strategies: chemotherapy followed by up-front UBMT at 6 months, and chemotherapy followed by up-front CBT at 3 months. Patients were stratified into low-, intermediate-, and high-risk groups according to the modified ATL-prognostic index. The model simulated life expectancy (LE) and quality-adjusted LE (QALE). LE following up-front UBMT was higher than that following up-front CBT in the low-risk group (2.63 vs. 2.28 years), but was comparable in the intermediate- (2.06 vs. 2.01 years) and high-risk groups (1.25 vs. 1.30 years). The Monte Carlo simulation for LE and QALE in each risk group showed that there was significant uncertainty in all categories. In conclusion, up-front UBMT was superior to up-front CBT in the low-risk group, but the strategies were comparable in the intermediate- and high-risk groups.