All content on this site is intended for healthcare professionals only. By acknowledging this message and accessing the information on this website you are confirming that you are a Healthcare Professional. If you are a patient or carer, please visit Know AML.
Introducing
Now you can personalise
your AML Hub experience!
Bookmark content to read later
Select your specific areas of interest
View content recommended for you
Find out moreThe AML Hub website uses a third-party service provided by Google that dynamically translates web content. Translations are machine generated, so may not be an exact or complete translation, and the AML Hub cannot guarantee the accuracy of translated content. The AML Hub and its employees will not be liable for any direct, indirect, or consequential damages (even if foreseeable) resulting from use of the Google Translate feature. For further support with Google Translate, visit Google Translate Help.
The AML Hub is an independent medical education platform, sponsored by Daiichi Sankyo, Jazz Pharmaceuticals, Kura Oncology, Roche and Syndax and has been supported through a grant from Bristol Myers Squibb. The funders are allowed no direct influence on our content. The levels of sponsorship listed are reflective of the amount of funding given. View funders.
Bookmark this article
Data regarding the use of hematopoietic stem cell transplantation (HSCT) is limited and controversial in adolescents and young adults (AYAs), which is also true of studies using umbilical cord blood (UCB) as an alternative donor source.
On Tuesday 26 March 2019, during the 45th European Society for Blood and Marrow Transplantation (EBMT), Hiromi Hayashi, Eurocord, Hôpital Saint Louis, APHP and IUH, Paris, FR, presented the outcomes of AYAs with acute leukemia who received an umbilical cord blood transplantation (UCBT) following a myeloablative conditioning regimen. The study was conducted on behalf of Eurocord, the Cellular Therapy and Immunobiology Working Party (CTIWP) and Paediatric Diseases Working Party (PDWP) and was presented during the meeting in Frankfurt, Germany.1
AYAs represent a heterogeneous population of patients for whom the treatment protocols are not well defined; some are treated with pediatric regimens whereas others may receive more intensive chemotherapy traditionally given to adults. Additionally, the age range represented by AYAs is not mutually agreed upon, with some definitions ranging from 15 to 39.
This study aimed to investigate the use of UCBT in patients aged 15–25 with acute leukemia following a myeloablative conditioning regimen. By restricting the age range, the authors aimed to make the population more homogenous.
Table 1: Summary of patient outcomes
Outcome measure |
Result (95% CI) |
---|---|
3-year leukemia free survival (LFS) (n = 504): - CR1 (n = 207) - CR2 (n = 183) - Advanced (n = 96) |
40.9 ± 2.3% 48.5 ± 3.7% 48.1 ± 3.9% 19.8 ± 4.3% |
CIF Graft-versus-host disease (GvHD): - Grade II–IV acute GvHD (aGvHD), day 100 - Chronic GvHD (cGvHD), 3-years |
27.8% (23.8–31.9) 25.3% (21.4–29.3) |
Relapse - CR1 - CR2 - Advanced |
27.9% (23.9–32.1) 27.6% (21.4–31.4) 24.3% (8.1–31.1) 36.8% (26.7–46.9) |
3-year overall survival (OS) By disease status (P < 0.001): - CR1 - CR2 - Advanced |
45 ± 2%
54 ± 4% 48 ± 4% 20 ± 4% |
3- year refined GvHD relapse free survival (rGRFS) |
31.5 ± 2% |
3-year CIF transplant related mortality (TRM) |
31.1% (24–33) |
Main causes of death: - Relapse - TRM |
41% 57% |
Table 2: Factors associated with outcome in multivariate analysis
Outcome measure |
Factor associated |
P value (95% CI) |
HR (95% CI) |
---|---|---|---|
3-year LFS |
Improved LFS: More recent UCBT (2010–2016 vs 2004–2009) |
0.02 |
0.73 (0.56–0.95) |
|
Poor LFS: Use of ATG Advanced disease status (vs CR1) |
0.02 >0.001 |
1.42 (1.05–1.92) 2.50 (1.81–3.45) |
aGvHD |
Reduced risk aGvHD: Use of ATG More recent UCBT |
0.01 0.03 |
0.54 (0.34–0.86) 0.67 (0.46–0.97) |
|
Higher risk aGvHD: Double UCBT |
0.02 |
1.65 (1.07–2.53) |
Relapse |
Higher relapse rate: Advanced disease status (vs CR1) |
0.01 |
1.89 (1.15–3.11) |
3-year OS |
Increased OS: More recent UCBT Better disease status |
0.002 < 0.001 |
0.76 (0.62–0.90) 0.36 (0.24–0.53) |
3-year rGRFS |
Higher rGRFS: More recent UCBT Better disease status Negative cyto-megalovirus serology |
0.47 0.008 0.037 |
0.85 (0.73–0.99) 0.60 (0.41–0.88) 0.77 (0.60–0.99) |
Between 2004–2009 and 2010–2016, the 3-year OS for AYAs has improved from 36.8% ± 3.2 to 53.8% ± 3.5, bringing this in line with the OS seen in children.
Your opinion matters
Subscribe to get the best content related to AML delivered to your inbox