Artigo Acesso aberto

Impact of Graft-versus-Host Disease Prophylaxis on Outcomes after Myeloablative Single-Unit Umbilical Cord Blood Transplantation

2013; Elsevier BV; Volume: 19; Issue: 9 Linguagem: Inglês

10.1016/j.bbmt.2013.07.004

ISSN

1523-6536

Autores

Jaime Sanz, Alessandra Picardi, Juan Carlos Hernández‐Boluda, Carmen Martín, Christelle Ferrà, Chiara Nozzoli, Marta González‐Vicent, Alessandro Rambaldi, David Valcárcel, Amparo Verdeguer, David Serrano, Cristina Díaz de Heredia, María Pascual, Raquel de Paz, Pau Montesinos, Benedetta Bartolozzi, Alessandra Algarotti, Miguel Á. Sanz, William Arcese, Guillermo Sanz,

Tópico(s)

Renal Transplantation Outcomes and Treatments

Resumo

Abstract Myeloablative single-unit umbilical cord blood transplantation (sUCBT) using busulfan, thiotepa, fludarabine, and antithymocyte globulin (Grupo Español de Trasplante Hematopoyético [GETH]-2005 protocol) resulted in high rates of engraftment and high antitumor activity. We designed a new graft-versus-host disease prophylaxis, substituting long-term steroids with mycophenolate mofetil together with a slight reduction of antithymocyte globulin (GETH/Gruppo Italiano Trapianto Midollo Osseo [GITMO]-2008 protocol). The results in 145 consecutive patients were compared with those obtained in 88 patients from the previous GETH-2005 trial. The cumulative incidence (CI) of myeloid engraftment at 60 days for patients in the GETH-2005 and GETH/GITMO-2008 trials was 94% and 88%, respectively, at a median time to neutrophil recovery of 19 and 23 days, respectively ( P < .0001). In the multivariable analyses, platelet engraftment, acute and chronic graft-versus-host disease, nonrelapse mortality, relapse, and event-free survival were not significantly different. The 3-year event-free survival rate in the GETH/GITMO-2008 trial was 66%, 31%, and 25% for patients transplanted in early, intermediate, and advanced stages of the disease, respectively ( P < .0001). This study confirms that myeloablative sUCBT using busulfan-based conditioning is a valuable strategy for patients with hematological malignancies. The use of mycophenolate mofetil apparently had an adverse effect on myeloid engraftment, and therefore a cautious use of this agent is warranted in the UCBT setting.

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