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Effect of conditioning regimens and GVHD prophylaxis on the outcomes of umbilical cord blood transplantation performed with cyclophosphamide/total-body irradiation-based regimens
Umbilical cord blood (UCB) is a valuable alternative donor source for allogeneic hematopoietic stem cell transplantation. Various conditioning regimens and graft-versus-host disease (GVHD) prophylaxis are explored to improve the outcomes of umbilical cord blood transplantation (UCBT). However, the d...
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Published in: | Transplantation and cellular therapy 2023-12 |
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Main Authors: | , , , , , , , , , , , , , , , , , , |
Format: | Article |
Language: | English |
Online Access: | Get full text |
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Summary: | Umbilical cord blood (UCB) is a valuable alternative donor source for allogeneic hematopoietic stem cell transplantation. Various conditioning regimens and graft-versus-host disease (GVHD) prophylaxis are explored to improve the outcomes of umbilical cord blood transplantation (UCBT). However, the differences in their effects remain unclear.
To elucidate the differences in the effects of conditioning regimens and GVHD prophylaxis on UCBT outcomes by disease type in a nationwide, retrospective study.
We retrospectively analyzed the effects of conditioning regimens and GVHD prophylaxis on the outcomes of UCBT performed with cyclophosphamide/total-body irradiation (CY/TBI)-based regimens in patients with acute myeloid leukemia (AML; n=1126), acute lymphoblastic leukemia (ALL; n=620), myelodysplastic syndrome (MDS; n=170), and lymphoma (n=128).
Multivariate analysis for overall survival (OS) demonstrated the benefit of adding high-dose cytarabine to the CY/TBI regimen for the AML (relative risk [RR], 0.76; P=0.003) and lymphoma (RR, 0.54; P=0.02) groups, but not in the ALL and MDS groups. The benefit of adding etoposide to the CY/TBI regimen was tested in the ALL group; it was associated with a lower OS (RR, 1.45; P=0.03). In the case of GVHD prophylaxis, tacrolimus/methotrexate regimen resulted in a lower OS than the cyclosporine/methotrexate regimen in the AML group (RR, 1.26; P=0.01); this was not observed in the other groups. These differences in OS according to the conditioning regimen and GVHD prophylaxis were mainly attributable to differences in relapse risk.
The effects of conditioning regimens and GVHD prophylaxis on UCBT outcomes differed according to disease type. UCBT outcomes could be improved by selecting optimal conditioning regimens and GVHD prophylaxis for each disease type. |
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ISSN: | 2666-6367 |