Outcomes after Umbilical Cord Blood Transplantation for Myelodysplastic Syndromes

Aaron T. Gerds, Kwang Woo Ahn, Zhen Huan Hu, Hisham Abdel-Azim, Gorgun Akpek, Mahmoud Aljurf, Karen K. Ballen, Amer Beitinjaneh, Ulrike Bacher, Jean Yves Cahn, Saurabh Chhabra, Corey Cutler, Andrew Daly, Zachariah DeFilipp, Robert Peter Gale, Usama Gergis, Michael R. Grunwald, Gregory A. Hale, Betty Ky Hamilton, Madan JagasiaRammurti T. Kamble, Tamila Kindwall-Keller, Taiga Nishihori, Richard F. Olsson, Muthalagu Ramanathan, Ayman A. Saad, Melhem Solh, Celalettin Ustun, David Valcárcel, Erica Warlick, Baldeep M. Wirk, Matt Kalaycio, Edwin Alyea, Uday Popat, Ronald Sobecks, Wael Saber

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

For patients with hematologic malignancies undergoing allogeneic hematopoietic cell transplantation, umbilical cord blood transplantation (UCBT) has become an acceptable alternative donor source in the absence of a matched sibling or unrelated donor. To date, however, there have been few published series dedicated solely to describing the outcomes of adult patients with myelodysplastic syndrome (MDS) who have undergone UCBT. Between 2004 and 2013, 176 adults with MDS underwent UCBT as reported to the Center for International Blood and Marrow Transplant Research. Median age at the time of transplantation was 56 years (range, 18-73 years). The study group included 10% with very low, 23% with low, 19% with intermediate, 19% with high, and 13% with very high-risk Revised International Prognostic Scoring System (IPSS-R) scores. The 100-day probability of grade II-IV acute graft-versus-host disease (GVHD) was 38%, and the 3-year probability of chronic GVHD was 28%. The probabilities of relapse and transplantation-related mortality (TRM) at 3 years were 32% and 40%, respectively, leading to a 3-year disease-free survival (DFS) of 28% and an overall survival (OS) of 31%. In multivariate analysis, increasing IPSS-R score at the time of HCT was associated with inferior TRM (P = .0056), DFS (P = .018), and OS (P = .0082), but not with GVHD or relapse. The presence of pretransplantation comorbidities was associated with TRM (P = .001), DFS (P = .02), and OS (P = .001). Reduced-intensity conditioning was associated with increased risk of relapse (relative risk, 3.95; 95% confidence interval, 1.78-8.75; P < .001), and although a higher proportion of myeloablative UCBTs were performed in patients with high-risk disease, the effect of conditioning regimen intensity was the same regardless of IPSS-R score. For some individuals who lack a matched sibling or unrelated donor, UCBT can result in long-term DFS; however, the success of UCBT in this population is hampered by a high rate of TRM.

Original languageEnglish (US)
Pages (from-to)971-979
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Volume23
Issue number6
DOIs
StatePublished - Jun 2017

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

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