Abstract
Treatments for patients with hematologic malignancies not in remission are limited, but a few clinical studies have investigated the effects of salvaged unrelated cord blood transplantation (CBT). We retrospectively studied 19 patients with acute leukemia, 5 with myelodysplastic syndrome (MDS with refractory anemia with excess blasts [RAEB]), and 2 with non-Hodgkin's lymphoma who received 1 CBT unit ≤2 loci human leukocyte antigen (HLA)-mismatched after undergoing myeloablative conditioning regimens between July 2005 and July 2014. All of them were in non-remission before transplantation. The infused total nucleated cell (TNC) dose was 4.07 (range 2.76-6.02)×107/kg and that of CD34+ stem cells was 2.08 (range 0.99-8.65)×105/kg. All patients were engrafted with neutrophils that exceeded 0.5×109/L on median day +17 (range 14-37 days) and had platelet counts of >20×109/L on median day +35 (range 17-70 days). Sixteen patients (61.5%) experienced pre-engraftment syndrome (PES), and six (23.1%) patients progressed to acute graft-versus-host disease (GVHD). The cumulative incidence rates of II-IV acute GVHD and chronic GVHD were 50% and 26.9%, respectively. After a median follow-up of 27 months (range 5-74), 14 patients survived and 3 relapsed. The estimated 2-year overall survival (OS), disease-free survival (DFS), and non-relapse mortality (NRM) rates were 50.5%, 40.3%, and 35.2%, respectively. Salvaged CBT might be a promising modality for treating hematologic malignancies, even in patients with a high leukemia burden.
Highlights
Patients with hematologic malignancies not in remission have very poor outcomes, and allogeneic hematopoietic stem cell transplantation is the only possibly effective treatment
We retrospectively studied 19 patients with acute leukemia, 5 with myelodysplastic syndrome (MDS with refractory anemia with excess blasts [RAEB]), and 2 with non-Hodgkin’s lymphoma who received 1 cord blood transplantation (CBT) unit #2 loci human leukocyte antigen (HLA)-mismatched after undergoing myeloablative conditioning regimens between July 2005 and July 2014
CBT procedures can safely provide a strong graft versus leukemia/lymphoma (GvL) effect [2,3], especially for high-risk hematologic malignancies, and a high disease-free survival rate [4]
Summary
Patients with hematologic malignancies not in remission have very poor outcomes, and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only possibly effective treatment. Umbilical cord blood transplantation (CBT) has the advantages of being rapidly available, and having a lower incidence of graftversus-host disease (GVHD) and less strict HLA-matching requirements owing to lower numbers and more immature T lymphocytes. This report describes 26 patients with myeloid and lymphoid malignancies who were not in remission at the time of transplantation and who were treated with myeloablative regimens in preparation for CBT at our center. They were followed for a median of 27 months from the date of transplantation
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