Outcomes of Unrelated Cord Blood and Haploidentical Stem Cell Transplantation in Adults with Acute Leukaemia.

Unrelated cord blood transplantation (UCBT) and Haploidentical T-cell depleted peripheral blood stem cell transplantation (Haplo) are alternative options to treat patients with high risk acute leukaemia. With the aim to compare the outcomes of both strategies we have analysed retrospectively adults patients with ALL or AML receiving either UCBT or Haplo performed in EBMT centers from 1998–2002. One hundred forty four patients had ALL (Haplo=75 and UCBT=73) and 220 had de novo AML (Haplo=154, UCBT=66). In the ALL group, UCBT patients were younger and received less TBI than Haplo recipients. The frequency of patients with advanced phase of the disease at transplant was 45% in Haplo and 51% in UCBT (p=0.79). Cytogenetics and interval from diagnosis to transplant were not statistically different between the 2 groups. In the AML group, UCBT recipients were younger than Haplo recipients. Many patients were transplanted in advanced phase of the disease in both groups (58% of Haplo recipient and 59% in UCBT group), other disease-related factors were not significantly different. Unadjusted outcomes in both groups are reported in table 1.

After statistical adjustment for differences between the 2 groups, in both analysis (ALL and AML), UCBT recipients had delayed neutrophil recovery and higher incidence of acute GVHD (II–IV) compared to Haplo recipients. In the AML group, relapse incidence, TRM and LFS were not statistically different after UCBT or Haplo, however in ALL group, LFS were superior and relapse incidence decreased after UCBT compared to Haplo transplants. In conclusion, in this based registry retrospective analysis, UCBT and Haplo showed similar TRM, relapse and LFS for adults with AML, however LFS were superior after UCBT for patients with ALL due to decreased incidence of relapse.