Reduced Intensity Hematopoietic-cell Transplantation in Older Patients with AML/MDS: Umbilical Cord Blood is a Feasible Option for Patients without HLA-matched Sibling Donors

摘要

Umbilical cord blood (UCB) has increased access to hematopoietic-cell transplantation (HCT) for patients without HLA-matched sibling donors (MSD). We compared outcomes of HCT using MSD (N=38) or UCB (N=60) among older patients (age ≥55 years) with acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS). All patients received a reduced intensity regimen consisting of cyclophosphamide, fludarabine and 200 cGy total body irradiation. Median age at HCT was 63 years for MSD and 61 years for UCB recipients. Among UCB recipients, 95% received two UCB units and 88% received 1–2 locus HLA mismatched units to optimize cell dose. Overall survival at 3-years was 37% for MSD and 31% for UCB recipients (P=0.21). On multivariate analysis, donor source (MSD vs. UCB) did not impact risks of overall survival, leukemia-free survival, relapse or treatment-related mortality. UCB is feasible as an alternative donor source for RIC HCT among older patients with AML and MDS who do not have a suitable MSD.