Unrelated Cord Blood Transplantation for Acute Leukemia Diagnosed in the First Year of Life: Outcomes and Risk Factor Analysis.
Identifieur interne : 000106 ( Main/Exploration ); précédent : 000105; suivant : 000107Unrelated Cord Blood Transplantation for Acute Leukemia Diagnosed in the First Year of Life: Outcomes and Risk Factor Analysis.
Auteurs : Annalisa Ruggeri [France] ; Fernanda Volt [France] ; Franco Locatelli [Italie] ; Gerard Michel [France] ; Cristina Diaz De Heredia [Espagne] ; Manuel Abecasis [Portugal] ; Marco Zecca [Italie] ; Ajay Vora [Royaume-Uni] ; Karima Yakouben [France] ; Tracey A. O'Brien [Australie] ; Stefano Giardino [Italie] ; Jacqueline Cornish [Royaume-Uni] ; Vanderson Rocha [Brésil] ; Christina Peters [Autriche] ; Peter Bader [Allemagne] ; Eliane Gluckman [Monaco] ; Jean Hugues Dalle [France]Source :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [ 1523-6536 ] ; 2017.
Abstract
Infant acute leukemia still has a poor prognosis, and allogeneic hematopoietic stem cell transplantation is indicated in selected patients. Umbilical cord blood (UCB) is an attractive cell source for this population because of the low risk of chronic graft-versus-host disease (GVHD), the strong graft-versus-leukemia effect, and prompt donor availability. This retrospective, registry-based study reported UCB transplantation (UCBT) outcomes in 252 children with acute lymphoblastic leukemia (ALL; n = 157) or acute myelogenous leukemia (AML; n = 95) diagnosed before 1 year of age who received a single-unit UCBT after myeloablative conditioning between 1996 and 2012 in European Society for Blood and Marrow Transplantation centers. Median age at UCBT was 1.1 years, and median follow-up was 42 months. Most patients (57%) received a graft with 1 HLA disparity and were transplanted in first complete remission (CR; 55%). Cumulative incidence function (CIF) of day 100 acute GVHD (grades II to IV) was 40% ± 3% and of 4-year chronic GVHD was 13% ± 2%. CIF of 1-year transplant-related mortality was 23% ± 3% and of 4-year relapse was 27% ± 3%. Leukemia-free-survival (LFS) at 4 years was 50% ± 3%; it was 40% and 66% for those transplanted for ALL and AML, respectively (P = .001). LFS was better for patients transplanted in first CR, regardless of diagnosis. In multivariate model, diagnosis of ALL (P = .001), advanced disease status at UCBT (<.001), age at diagnosis younger than 3 months (P = .012), and date of transplant before 2004 were independently associated with worse LFS. UCBT is a suitable option for patients diagnosed with infant acute leukemia who achieve CR. In this cohort, patients with AML had better survival than those with ALL.
DOI: 10.1016/j.bbmt.2016.10.014
PubMed: 27777140
Affiliations:
- Allemagne, Australie, Autriche, Brésil, Espagne, France, Italie, Monaco, Portugal, Royaume-Uni
- Catalogne, District de Darmstadt, Hesse (Land), Nouvelle-Galles du Sud, Provence-Alpes-Côte d'Azur, Vienne (Autriche), État de São Paulo, Île-de-France
- Barcelone, Francfort-sur-le-Main, Marseille, Paris, Sydney, São Paulo, Vienne (Autriche)
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Electronic address: annalisa.ruggeri@aphp.fr.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Service d'Hématologie et Therapie cellulaire, Hôpital Saint Antoine, Paris, France; Eurocord, University Paris VII IUH Paris</wicri:regionArea><wicri:noRegion>University Paris VII IUH Paris</wicri:noRegion><wicri:noRegion>University Paris VII IUH Paris</wicri:noRegion></affiliation></author><author><name sortKey="Volt, Fernanda" sort="Volt, Fernanda" uniqKey="Volt F" first="Fernanda" last="Volt">Fernanda Volt</name><affiliation wicri:level="1"><nlm:affiliation>Eurocord, University Paris VII IUH Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Eurocord, University Paris VII IUH Paris</wicri:regionArea><wicri:noRegion>University Paris VII IUH Paris</wicri:noRegion><wicri:noRegion>University Paris VII IUH Paris</wicri:noRegion></affiliation></author><author><name sortKey="Locatelli, Franco" sort="Locatelli, Franco" uniqKey="Locatelli F" first="Franco" last="Locatelli">Franco Locatelli</name><affiliation wicri:level="1"><nlm:affiliation>Dipartimento di Oncoematologia Pediatrica, Ospedale Bambino Gesù, IRCSS, Roma, Università di Pavia, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Dipartimento di Oncoematologia Pediatrica, Ospedale Bambino Gesù, IRCSS, Roma, Università di Pavia</wicri:regionArea><wicri:noRegion>Università di Pavia</wicri:noRegion></affiliation></author><author><name sortKey="Michel, Gerard" sort="Michel, Gerard" uniqKey="Michel G" first="Gerard" last="Michel">Gerard Michel</name><affiliation wicri:level="3"><nlm:affiliation>Hôpital d'Enfants de la Timone, Marseille, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Hôpital d'Enfants de la Timone, Marseille</wicri:regionArea><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Marseille</settlement></placeName></affiliation></author><author><name sortKey="Diaz De Heredia, Cristina" sort="Diaz De Heredia, Cristina" uniqKey="Diaz De Heredia C" first="Cristina" last="Diaz De Heredia">Cristina Diaz De Heredia</name><affiliation wicri:level="3"><nlm:affiliation>Servicio de Hematologia y Oncologia Pediátrica, Hospital Vall d'Hebron, Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Servicio de Hematologia y Oncologia Pediátrica, Hospital Vall d'Hebron, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Abecasis, Manuel" sort="Abecasis, Manuel" uniqKey="Abecasis M" first="Manuel" last="Abecasis">Manuel Abecasis</name><affiliation wicri:level="1"><nlm:affiliation>BMT Unit, Inst. Portugues Oncologia, Porto, Portugal.</nlm:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>BMT Unit, Inst. 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O'Brien</name><affiliation wicri:level="3"><nlm:affiliation>Sydney Children's Hospital, Kids Cancer Centre, Sydney, Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Sydney Children's Hospital, Kids Cancer Centre, Sydney</wicri:regionArea><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Giardino, Stefano" sort="Giardino, Stefano" uniqKey="Giardino S" first="Stefano" last="Giardino">Stefano Giardino</name><affiliation wicri:level="1"><nlm:affiliation>UOSD Trapianto di Midollo, Istituto G. Gaslini, Largo G. Gaslini, Genova, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>UOSD Trapianto di Midollo, Istituto G. Gaslini, Largo G. 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Electronic address: annalisa.ruggeri@aphp.fr.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Service d'Hématologie et Therapie cellulaire, Hôpital Saint Antoine, Paris, France; Eurocord, University Paris VII IUH Paris</wicri:regionArea><wicri:noRegion>University Paris VII IUH Paris</wicri:noRegion><wicri:noRegion>University Paris VII IUH Paris</wicri:noRegion></affiliation></author><author><name sortKey="Volt, Fernanda" sort="Volt, Fernanda" uniqKey="Volt F" first="Fernanda" last="Volt">Fernanda Volt</name><affiliation wicri:level="1"><nlm:affiliation>Eurocord, University Paris VII IUH Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Eurocord, University Paris VII IUH Paris</wicri:regionArea><wicri:noRegion>University Paris VII IUH Paris</wicri:noRegion><wicri:noRegion>University Paris VII IUH Paris</wicri:noRegion></affiliation></author><author><name sortKey="Locatelli, Franco" sort="Locatelli, Franco" uniqKey="Locatelli F" first="Franco" last="Locatelli">Franco Locatelli</name><affiliation wicri:level="1"><nlm:affiliation>Dipartimento di Oncoematologia Pediatrica, Ospedale Bambino Gesù, IRCSS, Roma, Università di Pavia, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Dipartimento di Oncoematologia Pediatrica, Ospedale Bambino Gesù, IRCSS, Roma, Università di Pavia</wicri:regionArea><wicri:noRegion>Università di Pavia</wicri:noRegion></affiliation></author><author><name sortKey="Michel, Gerard" sort="Michel, Gerard" uniqKey="Michel G" first="Gerard" last="Michel">Gerard Michel</name><affiliation wicri:level="3"><nlm:affiliation>Hôpital d'Enfants de la Timone, Marseille, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Hôpital d'Enfants de la Timone, Marseille</wicri:regionArea><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Marseille</settlement></placeName></affiliation></author><author><name sortKey="Diaz De Heredia, Cristina" sort="Diaz De Heredia, Cristina" uniqKey="Diaz De Heredia C" first="Cristina" last="Diaz De Heredia">Cristina Diaz De Heredia</name><affiliation wicri:level="3"><nlm:affiliation>Servicio de Hematologia y Oncologia Pediátrica, Hospital Vall d'Hebron, Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Servicio de Hematologia y Oncologia Pediátrica, Hospital Vall d'Hebron, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Abecasis, Manuel" sort="Abecasis, Manuel" uniqKey="Abecasis M" first="Manuel" last="Abecasis">Manuel Abecasis</name><affiliation wicri:level="1"><nlm:affiliation>BMT Unit, Inst. Portugues Oncologia, Porto, Portugal.</nlm:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>BMT Unit, Inst. Portugues Oncologia, Porto</wicri:regionArea><wicri:noRegion>Porto</wicri:noRegion></affiliation></author><author><name sortKey="Zecca, Marco" sort="Zecca, Marco" uniqKey="Zecca M" first="Marco" last="Zecca">Marco Zecca</name><affiliation wicri:level="1"><nlm:affiliation>Unità di Onco-Ematologia, IRCCS Policlinico San Matteo, Pavia, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Unità di Onco-Ematologia, IRCCS Policlinico San Matteo, Pavia</wicri:regionArea><wicri:noRegion>Pavia</wicri:noRegion></affiliation></author><author><name sortKey="Vora, Ajay" sort="Vora, Ajay" uniqKey="Vora A" first="Ajay" last="Vora">Ajay Vora</name><affiliation wicri:level="1"><nlm:affiliation>Department of Haematology, Sheffield Children's Hospital and University of Sheffield, Sheffield, United Kingdom.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Haematology, Sheffield Children's Hospital and University of Sheffield, Sheffield</wicri:regionArea><wicri:noRegion>Sheffield</wicri:noRegion></affiliation></author><author><name sortKey="Yakouben, Karima" sort="Yakouben, Karima" uniqKey="Yakouben K" first="Karima" last="Yakouben">Karima Yakouben</name><affiliation wicri:level="3"><nlm:affiliation>Service d'Hématologie, Hôpital Robert Debré, APHP, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Service d'Hématologie, Hôpital Robert Debré, APHP, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="O Brien, Tracey A" sort="O Brien, Tracey A" uniqKey="O Brien T" first="Tracey A" last="O'Brien">Tracey A. O'Brien</name><affiliation wicri:level="3"><nlm:affiliation>Sydney Children's Hospital, Kids Cancer Centre, Sydney, Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Sydney Children's Hospital, Kids Cancer Centre, Sydney</wicri:regionArea><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Giardino, Stefano" sort="Giardino, Stefano" uniqKey="Giardino S" first="Stefano" last="Giardino">Stefano Giardino</name><affiliation wicri:level="1"><nlm:affiliation>UOSD Trapianto di Midollo, Istituto G. Gaslini, Largo G. Gaslini, Genova, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>UOSD Trapianto di Midollo, Istituto G. Gaslini, Largo G. Gaslini, Genova</wicri:regionArea><wicri:noRegion>Genova</wicri:noRegion></affiliation></author><author><name sortKey="Cornish, Jacqueline" sort="Cornish, Jacqueline" uniqKey="Cornish J" first="Jacqueline" last="Cornish">Jacqueline Cornish</name><affiliation wicri:level="1"><nlm:affiliation>Bristol Royal Hospital for Children, Bristol, United Kingdom.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Bristol Royal Hospital for Children, Bristol</wicri:regionArea><wicri:noRegion>Bristol</wicri:noRegion></affiliation></author><author><name sortKey="Rocha, Vanderson" sort="Rocha, Vanderson" uniqKey="Rocha V" first="Vanderson" last="Rocha">Vanderson Rocha</name><affiliation wicri:level="3"><nlm:affiliation>Eurocord, University Paris VII IUH Paris, France; Sirio Libanes Hospital and University of Sao Paulo, Sao Paulo, Brazil.</nlm:affiliation><country xml:lang="fr">Brésil</country><wicri:regionArea>Eurocord, University Paris VII IUH Paris, France; Sirio Libanes Hospital and University of Sao Paulo, Sao Paulo</wicri:regionArea><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Peters, Christina" sort="Peters, Christina" uniqKey="Peters C" first="Christina" last="Peters">Christina Peters</name><affiliation wicri:level="3"><nlm:affiliation>BMT Unit, St. Anna Kinderspital, Vienna, Austria.</nlm:affiliation><country xml:lang="fr">Autriche</country><wicri:regionArea>BMT Unit, St. Anna Kinderspital, Vienna</wicri:regionArea><placeName><settlement type="city">Vienne (Autriche)</settlement><region nuts="2" type="province">Vienne (Autriche)</region></placeName></affiliation></author><author><name sortKey="Bader, Peter" sort="Bader, Peter" uniqKey="Bader P" first="Peter" last="Bader">Peter Bader</name><affiliation wicri:level="3"><nlm:affiliation>Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt</wicri:regionArea><placeName><region type="land" nuts="1">Hesse (Land)</region><region type="district" nuts="2">District de Darmstadt</region><settlement type="city">Francfort-sur-le-Main</settlement></placeName></affiliation></author><author><name sortKey="Gluckman, Eliane" sort="Gluckman, Eliane" uniqKey="Gluckman E" first="Eliane" last="Gluckman">Eliane Gluckman</name><affiliation wicri:level="1"><nlm:affiliation>Eurocord, University Paris VII IUH Paris, France; Monacord Centre Scientifique de Monaco, Monaco.</nlm:affiliation><country xml:lang="fr">Monaco</country><wicri:regionArea>Eurocord, University Paris VII IUH Paris, France; Monacord Centre Scientifique de Monaco</wicri:regionArea><wicri:noRegion>France; Monacord Centre Scientifique de Monaco</wicri:noRegion></affiliation></author><author><name sortKey="Dalle, Jean Hugues" sort="Dalle, Jean Hugues" uniqKey="Dalle J" first="Jean Hugues" last="Dalle">Jean Hugues Dalle</name><affiliation wicri:level="3"><nlm:affiliation>Service d'Hématologie, Hôpital Robert Debré, APHP, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Service d'Hématologie, Hôpital Robert Debré, APHP, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author></analytic><series><title level="j">Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation</title><idno type="eISSN">1523-6536</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Infant acute leukemia still has a poor prognosis, and allogeneic hematopoietic stem cell transplantation is indicated in selected patients. Umbilical cord blood (UCB) is an attractive cell source for this population because of the low risk of chronic graft-versus-host disease (GVHD), the strong graft-versus-leukemia effect, and prompt donor availability. This retrospective, registry-based study reported UCB transplantation (UCBT) outcomes in 252 children with acute lymphoblastic leukemia (ALL; n = 157) or acute myelogenous leukemia (AML; n = 95) diagnosed before 1 year of age who received a single-unit UCBT after myeloablative conditioning between 1996 and 2012 in European Society for Blood and Marrow Transplantation centers. Median age at UCBT was 1.1 years, and median follow-up was 42 months. Most patients (57%) received a graft with 1 HLA disparity and were transplanted in first complete remission (CR; 55%). Cumulative incidence function (CIF) of day 100 acute GVHD (grades II to IV) was 40% ± 3% and of 4-year chronic GVHD was 13% ± 2%. CIF of 1-year transplant-related mortality was 23% ± 3% and of 4-year relapse was 27% ± 3%. Leukemia-free-survival (LFS) at 4 years was 50% ± 3%; it was 40% and 66% for those transplanted for ALL and AML, respectively (P = .001). LFS was better for patients transplanted in first CR, regardless of diagnosis. In multivariate model, diagnosis of ALL (P = .001), advanced disease status at UCBT (<.001), age at diagnosis younger than 3 months (P = .012), and date of transplant before 2004 were independently associated with worse LFS. UCBT is a suitable option for patients diagnosed with infant acute leukemia who achieve CR. In this cohort, patients with AML had better survival than those with ALL.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>Autriche</li><li>Brésil</li><li>Espagne</li><li>France</li><li>Italie</li><li>Monaco</li><li>Portugal</li><li>Royaume-Uni</li></country><region><li>Catalogne</li><li>District de Darmstadt</li><li>Hesse (Land)</li><li>Nouvelle-Galles du Sud</li><li>Provence-Alpes-Côte d'Azur</li><li>Vienne (Autriche)</li><li>État de São Paulo</li><li>Île-de-France</li></region><settlement><li>Barcelone</li><li>Francfort-sur-le-Main</li><li>Marseille</li><li>Paris</li><li>Sydney</li><li>São Paulo</li><li>Vienne (Autriche)</li></settlement></list><tree><country name="France"><noRegion><name sortKey="Ruggeri, Annalisa" sort="Ruggeri, Annalisa" uniqKey="Ruggeri A" first="Annalisa" last="Ruggeri">Annalisa Ruggeri</name></noRegion><name sortKey="Dalle, Jean Hugues" sort="Dalle, Jean Hugues" uniqKey="Dalle J" first="Jean Hugues" last="Dalle">Jean Hugues Dalle</name><name sortKey="Michel, Gerard" sort="Michel, Gerard" uniqKey="Michel G" first="Gerard" last="Michel">Gerard Michel</name><name sortKey="Volt, Fernanda" sort="Volt, Fernanda" uniqKey="Volt F" first="Fernanda" last="Volt">Fernanda Volt</name><name sortKey="Yakouben, Karima" sort="Yakouben, Karima" uniqKey="Yakouben K" first="Karima" last="Yakouben">Karima Yakouben</name></country><country name="Italie"><noRegion><name sortKey="Locatelli, Franco" sort="Locatelli, Franco" uniqKey="Locatelli F" first="Franco" last="Locatelli">Franco Locatelli</name></noRegion><name sortKey="Giardino, Stefano" sort="Giardino, Stefano" uniqKey="Giardino S" first="Stefano" last="Giardino">Stefano Giardino</name><name sortKey="Zecca, Marco" sort="Zecca, Marco" uniqKey="Zecca M" first="Marco" last="Zecca">Marco Zecca</name></country><country name="Espagne"><region name="Catalogne"><name sortKey="Diaz De Heredia, Cristina" sort="Diaz De Heredia, Cristina" uniqKey="Diaz De Heredia C" first="Cristina" last="Diaz De Heredia">Cristina Diaz De Heredia</name></region></country><country name="Portugal"><noRegion><name sortKey="Abecasis, Manuel" sort="Abecasis, Manuel" uniqKey="Abecasis M" first="Manuel" last="Abecasis">Manuel Abecasis</name></noRegion></country><country name="Royaume-Uni"><noRegion><name sortKey="Vora, Ajay" sort="Vora, Ajay" uniqKey="Vora A" first="Ajay" last="Vora">Ajay Vora</name></noRegion><name sortKey="Cornish, Jacqueline" sort="Cornish, Jacqueline" uniqKey="Cornish J" first="Jacqueline" last="Cornish">Jacqueline Cornish</name></country><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="O Brien, Tracey A" sort="O Brien, Tracey A" uniqKey="O Brien T" first="Tracey A" last="O'Brien">Tracey A. O'Brien</name></region></country><country name="Brésil"><region name="État de São Paulo"><name sortKey="Rocha, Vanderson" sort="Rocha, Vanderson" uniqKey="Rocha V" first="Vanderson" last="Rocha">Vanderson Rocha</name></region></country><country name="Autriche"><region name="Vienne (Autriche)"><name sortKey="Peters, Christina" sort="Peters, Christina" uniqKey="Peters C" first="Christina" last="Peters">Christina Peters</name></region></country><country name="Allemagne"><region name="Hesse (Land)"><name sortKey="Bader, Peter" sort="Bader, Peter" uniqKey="Bader P" first="Peter" last="Bader">Peter Bader</name></region></country><country name="Monaco"><noRegion><name sortKey="Gluckman, Eliane" sort="Gluckman, Eliane" uniqKey="Gluckman E" first="Eliane" last="Gluckman">Eliane Gluckman</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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