Studies in patients with leukemia who are adolescents or young adults have been limited, but a research team recently examined treatment outcomes for patients in this population who underwent umbilical cord blood transplantation (UCBT) for acute leukemia. Results of this study were reported in Biology of Blood and Marrow Transplantation.
The study was a retrospective analysis of data from 504 patients included in the Eurocord database. Patients were between 15 and 25 years of age. The 3-year overall survival (OS) rate from the time of transplant was the primary end point.
Patients were treated with UCBT for acute lymphoblastic leukemia (58.9%) or acute myeloid leukemia (41.1%). UCBT was given within 1 year after an acute leukemia diagnosis in 52.0% of patients.
After a median study follow-up of 3.9 years, the 3-year OS rate was 45% and the leukemia-free survival (LFS) rate was 41%. In multivariate analysis, the OS rate was higher for patients with a more favorable disease status at the time of UCBT (hazard ratio [HR], 2.74; P <.001). Having had a more recent UCBT was also associated with higher OS.
Nonrelapse mortality occurred with a 3-year cumulative incidence of 31%, and the 3-year relapse rate was 28%. Acute graft-versus-host-disease (GVHD) of grades 2 to 4 occurred in 155 patients throughout the observation period, and the 3-year rate of chronic GVHD was 25%.
Double UCBT was associated with a raised risk for grade 2 to 4 acute GVHD (HR, 1.65; P =.02). Use of antithymocyte globulin and a more recent transplantation were each associated with a lower risk of grade 2 to 4 acute GVHD. The use of antithymocyte globulin was, however, linked to a poorer rate of LFS.
A total of 265 patients died during follow-up. The most common causes of fatality were relapse (41.0%), infection (28.2%), and GVHD (12.8%).
The researchers concluded that this study may enable improved insight into transplantation outcomes for adolescent and young adult patients.
- Hayashi H, Volt F, Sanz J, et al. Myeloablative unrelated cord blood transplantation in adolescents and young adults with acute leukemia [published online August 5, 2019]. Biol Blood Marrow Transplant. doi:10.1016/j.bbmt.2019.07.031