The following is a summary of “Higher survival following transplantation with a mismatched unrelated donor with posttransplant cyclophosphamide-based graft-versus-host disease prophylaxis than with double unit umbilical cord blood in patients with acute myeloid leukemia in first complete remission: A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation,” published in the August 2024 issue of Hematology by Baron et al.
The best donor option for patients with acute myeloid leukemia (AML) without an HLA-matched donor remains a topic of debate.
Researchers conducted a retrospective study comparing hematopoietic cell transplantation (HCT) outcomes between double-unit umbilical cord blood transplantation (dCBT) and 9/10 HLA-matched unrelated donors (UD 9/10) with posttransplant cyclophosphamide (PTCy) for graft-versus-host disease (GVHD) prevention in adult patients with AML in their first complete remission (CR1).
They included adult patients with AML in first complete remission (CR1), comparing those who received peripheral blood stem cells (PBSC) from UD 9/10 HCT with PTCy-based GVHD prophylaxis to those who had dCBT without PTCy. Between 2013-2021, 209 patients had dCBT, while 270 underwent UD 9/10 HCT. During this phase, no in vivo T-cell depletion was involved.
The results showed that the 180-day cumulative incidence of grade II-IV acute GVHD was higher in patients receiving dCBT (44%) compared to UD 9/10 (29%, P=0.001). After adjusting for other factors, dCBT was associated with higher non-relapse mortality (HR=2.35, 95% CI: 1.23-4.48, P=0.01), similar relapse rates (HR=1.12, 95% CI: 0.67-1.86, P=0.66), lower leukemia-free survival (HR=1.5, 95% CI: 1.01-2.23, P=0.047), and lower overall survival (HR=1.66, 95% CI: 1.08-2.55, P=0.02) compared to patients receiving UD 9/10 HCT.
Investigators concluded that UD 9/10 with PTCy-based GVHD prophylaxis leads to better outcomes than dCB for patients with AML.
Source: onlinelibrary.wiley.com/doi/abs/10.1002/ajh.27466
