Cord blood chimerism and relapse after haplo-cord transplantation.
Publication/Presentation Date
2-1-2017
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.
Volume
58
Issue
2
First Page
288
Last Page
297
ISSN
1029-2403
Published In/Presented At
van 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. (2017). Cord blood chimerism and relapse after haplo-cord transplantation. Leukemia & lymphoma, 58(2), 288–297. https://doi.org/10.1080/10428194.2016.1190970
Disciplines
Medicine and Health Sciences
PubMedID
27333804
Department(s)
Department of Medicine, Lehigh Valley Topper Cancer Institute
Document Type
Article