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Cord blood chimerism and relapse after haplo-cord transplantation.

TitleCord blood chimerism and relapse after haplo-cord transplantation.
Publication TypeJournal Article
Year of Publication2017
Authorsvan Besien K, Koshy N, Gergis U, Mayer S, Cushing M, Rennert H, Reich-Slotky R, Mark T, Pearse R, Rossi A, Phillips A, Vasovic L, Ferrante R, Hsu Y-M, Shore T
JournalLeuk Lymphoma
Volume58
Issue2
Pagination288-297
Date Published2017 02
ISSN1029-2403
KeywordsAdolescent, Adult, Aged, Alleles, Cord Blood Stem Cell Transplantation, Female, Graft vs Host Disease, Haplotypes, HLA Antigens, Humans, Immunosuppressive Agents, Incidence, Leukemia, Myeloid, Acute, Male, Middle Aged, Outcome Assessment (Health Care), Recurrence, Survival Analysis, Tissue Donors, Transplantation Chimera, Transplantation, Homologous, Young Adult
Abstract

Haplo-cord stem cell transplantation combines the infusion of CD34 selected hematopoietic progenitors from a haplo-identical donor with an umbilical cord blood (UCB) graft from an unrelated donor and allows faster count recovery, with low rates of disease recurrence and chronic graft-versus-host disease (GVHD). But the contribution of the umbilical cord blood graft to long-term transplant outcome remains unclear. We analyzed 39 recipients of haplo-cord transplants with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS), engrafted and in remission at 2 months. Median age was 66 (18-72) and all had intermediate, high, or very-high risk disease. Less than 20% UCB chimerism in the CD33 lineage was associated with an increased rate of disease recurrence (54% versus 11% p < 0.0001) and decrease in one year progression-free (20% versus 55%, p = 0.004) and overall survival (30% versus 62%, p = 0.02). Less than 100% UCB chimerism in the CD3 lineage was associated with increase rate of disease recurrence (46% versus 12%, p = 0.007). Persistent haplo-chimerism in the CD3 lineage was associated with an increased rate of disease recurrence (40% versus 15%, p = 0.009) Chimerism did not predict for treatment related mortality. The cumulative incidence of acute GVHD by day 100 was 43%. The cumulative incidence of moderate/severe chronic GVHD was only 5%. Engraftment of the umbilical cord blood grafts provides powerful graft-versus-leukemia (GVL) effects which protect against disease recurrence and is associated with low risk of chronic GVHD. Engraftment of CD34 selected haplo-identical cells can lead to rapid development of circulating T-cells, but when these cells dominate, GVL-effects are limited and rates of disease recurrence are high.

DOI10.1080/10428194.2016.1190970
Alternate JournalLeuk. Lymphoma
PubMed ID27333804
PubMed Central IDPMC5830127
Grant ListUL1 TR000457 / TR / NCATS NIH HHS / United States
UL1 TR002384 / TR / NCATS NIH HHS / United States