Abstract
Backgrounds: Umbilical cord blood can be an alternative stem cell source for the patients with hematological malignancies requiring allogeneic stem cell transplantation. However, little is known about graft versus leukemia/lymphoma (GVL) effect in cord blood transplantation (CBT). Here, we analyzed chronic GVHD (cGVHD) in CBT compared with that in BMT and evaluated the relevance between cGVHD and GVL.
Patients/methods: We retrospectively studied 162 patients who had been free from disease progression for more than 100 days after either unrelated BMT (n=75) or CBT (n=87) at Toranomon Hospital from January 2002 to October 2006. Median age of the patients was 52 years old (BMT vs CBT: 49 vs 53). Underlying diseases were acute leukemia (n=88), myelodysplastic syndrome (n=17), lymphoma (n=39) and others (n=18). Conditioning regimens were mainly composed of Fludarabine 125–180 mg/m2 with several combinations of Melphalan 80–140 mg/m2, Busulfan 8–16mg/kg and/or total body irradiation (4–8 Gy).
Results: The Median observation period after the transplantation was 612 days (range, 109–1944). The cumulative incidence of cGVHD was 84% in BMT and 62% in CBT (p=0.09). The severity of cGVHD was analyzed based on its type; limited or extensive. In CBT, the percentage of the former type was 34% (vs 25% in BMT) and the latter was 23% (vs 48% in BMT). High-risk disease (p=0.03) and preceding acute GVHD(p=0.03) are related to the occurrence of cGVHD. RICBT tended to increase cGVHD compared to CBT using BU/CY or CY/TBI regimen, Multivariative analysis showed that cGVHD increased overall survival (p<0.01) and suppressed recurrence of the disease (p<0.01). During observation period, no patients were died of cGVHD.
Discussion: We demonstrated that cGVHD in CBT is tolerable compared with that in BMT and that the occurrence of cGVHD could result in good prognosis. Our analysis also suggested that CBT could have GVL effect as well as BMT.
Author notes
Disclosure: No relevant conflicts of interest to declare.
