Results of comparative studies on BMT, PBSC and UCBT in adults with hematological malignancies
| Series . | Graft source, no. of patients . | Conditioning regimen intensity . | Conditioning regimen . | ATG (yes/no) . | Median follow-up, mo . | Comments (UCBT vs others) . | Reference . |
|---|---|---|---|---|---|---|---|
| UD vs UCBT for adults with acute leukemia | sUCB, n = 98 | MAC | sUCB: TBI-based, n = 64 | Yes | 27 | Delayed myeloid recovery | 47 |
| BM, n = 584 | Bu-based, n = 34 | Decreased aGVHD and cGVHD | |||||
| BM: TBI-based, n = 426 | Comparable OS and DFS | ||||||
| UCBT vs UD for adults with acute leukemia | sUCB, n = 287 | MAC | TBI-based, n = 720 | No | — | For AML: lower OS and DFS, higher NRM, no difference in RI | 60 |
| BM, n = 533 | Non TBI-based, n = 100 | For ALL: similar OS and DFS, no differences in RI and NRM | |||||
| UD vs single UCBT for adults with acute leukemia | BM, n = 472 | MAC | BM, TBI-based, n = 321 | Yes, 28% | 26 | Delayed myeloid recovery (vs BM) | 48 |
| PBSC, n = 888 | PBSC, TBI-based, n = 583 | Yes, 18% | 24 | Increased NRM but comparable OS and LFS (vs BM) | |||
| UCB, n = 165 | UCB, TBI-based, n = 90 | Yes, 72% | 29 | ||||
| Sibling, UD vs single UCBT | MRD, n = 204 | MAC | TBI + Cy | 36 | Comparable OS and LFS | 20 | |
| MUD, n = 152 | TCF (dUCBT) | Delayed myeloid recovery | |||||
| MMUD, n = 52 | Increased NRM, reduced relapse | ||||||
| dUCB, n = 128 | |||||||
| UD vs double UCBT for adults with acute leukemia | 8/8 PBSC, n = 313 | RIC | 8/8 PBSC Bu-based, n = 119 | Yes | 36 | Overall results comparable to 8/8 PBSC | 61 |
| 7/8 PBSC, n = 111 | 7/8 PBSC Bu-based, n = 46 | 24 | |||||
| dUCB, n = 161 | dUCB, TBI-based, n = 121 | 24 | |||||
| Non–T-cell–depleted haploidentical transplantation vs UCBT for adults with acute leukemia | AML, n = 918 (haploidentical = 360, UCBT = 558) | MAC and RIC | For MAC, TBF, n = 198 | Yes, in 60% of UCBT and 49% of haploidentical | AML, haploidentical 20 | Delayed engraftment | 19 |
| ALL, n = 528 (haploidentical = 158 UCBT = 370). | For RIC, TCF, n = 289 | AML UCBT 31 | Lower incidence of cGVHD | ||||
| ALL haploidentical 19 | Similar relapse, LFS, and NRM | ||||||
| ALL UCBT 17 | |||||||
| UCB vs MUD vs MMUD in AL and MDS | UCBT, n = 140 | MAC | Bu-based, n = 181 | In pre transplantation positive minimal residual disease: | 49 | ||
| MUD, n = 344 | TBI-based, n = 401 | Comparable outcomes after UCBT and MUD, lower relapse for UCBT | |||||
| MMUD, n = 98 | |||||||
| Influence of stem cell source on transplantation outcomes for pediatric AML | MRD, n = 61 | MAC | TBI-based, n = 136 | Yes, 21% | 144 | Comparable RI, LFS, and NRM for all sources | 62 |
| MUD, n = 73 | Chemotherapy-based, n = 181 | MRD allowed better OS | |||||
| UCB, n = 183 |
| Series . | Graft source, no. of patients . | Conditioning regimen intensity . | Conditioning regimen . | ATG (yes/no) . | Median follow-up, mo . | Comments (UCBT vs others) . | Reference . |
|---|---|---|---|---|---|---|---|
| UD vs UCBT for adults with acute leukemia | sUCB, n = 98 | MAC | sUCB: TBI-based, n = 64 | Yes | 27 | Delayed myeloid recovery | 47 |
| BM, n = 584 | Bu-based, n = 34 | Decreased aGVHD and cGVHD | |||||
| BM: TBI-based, n = 426 | Comparable OS and DFS | ||||||
| UCBT vs UD for adults with acute leukemia | sUCB, n = 287 | MAC | TBI-based, n = 720 | No | — | For AML: lower OS and DFS, higher NRM, no difference in RI | 60 |
| BM, n = 533 | Non TBI-based, n = 100 | For ALL: similar OS and DFS, no differences in RI and NRM | |||||
| UD vs single UCBT for adults with acute leukemia | BM, n = 472 | MAC | BM, TBI-based, n = 321 | Yes, 28% | 26 | Delayed myeloid recovery (vs BM) | 48 |
| PBSC, n = 888 | PBSC, TBI-based, n = 583 | Yes, 18% | 24 | Increased NRM but comparable OS and LFS (vs BM) | |||
| UCB, n = 165 | UCB, TBI-based, n = 90 | Yes, 72% | 29 | ||||
| Sibling, UD vs single UCBT | MRD, n = 204 | MAC | TBI + Cy | 36 | Comparable OS and LFS | 20 | |
| MUD, n = 152 | TCF (dUCBT) | Delayed myeloid recovery | |||||
| MMUD, n = 52 | Increased NRM, reduced relapse | ||||||
| dUCB, n = 128 | |||||||
| UD vs double UCBT for adults with acute leukemia | 8/8 PBSC, n = 313 | RIC | 8/8 PBSC Bu-based, n = 119 | Yes | 36 | Overall results comparable to 8/8 PBSC | 61 |
| 7/8 PBSC, n = 111 | 7/8 PBSC Bu-based, n = 46 | 24 | |||||
| dUCB, n = 161 | dUCB, TBI-based, n = 121 | 24 | |||||
| Non–T-cell–depleted haploidentical transplantation vs UCBT for adults with acute leukemia | AML, n = 918 (haploidentical = 360, UCBT = 558) | MAC and RIC | For MAC, TBF, n = 198 | Yes, in 60% of UCBT and 49% of haploidentical | AML, haploidentical 20 | Delayed engraftment | 19 |
| ALL, n = 528 (haploidentical = 158 UCBT = 370). | For RIC, TCF, n = 289 | AML UCBT 31 | Lower incidence of cGVHD | ||||
| ALL haploidentical 19 | Similar relapse, LFS, and NRM | ||||||
| ALL UCBT 17 | |||||||
| UCB vs MUD vs MMUD in AL and MDS | UCBT, n = 140 | MAC | Bu-based, n = 181 | In pre transplantation positive minimal residual disease: | 49 | ||
| MUD, n = 344 | TBI-based, n = 401 | Comparable outcomes after UCBT and MUD, lower relapse for UCBT | |||||
| MMUD, n = 98 | |||||||
| Influence of stem cell source on transplantation outcomes for pediatric AML | MRD, n = 61 | MAC | TBI-based, n = 136 | Yes, 21% | 144 | Comparable RI, LFS, and NRM for all sources | 62 |
| MUD, n = 73 | Chemotherapy-based, n = 181 | MRD allowed better OS | |||||
| UCB, n = 183 |
aGVHD, acute graft-versus-host disease; ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; ATG, antithymocyte globulin; BM, bone marrow; BMT, bone marrow transplantation; Bu, busulfan; cGVHD, chronic graft-versus-host disease; DFS, disease-free survival; dUCB, double umbilical cord blood; dUCBT, double umbilical cord blood transplantation; LFS, leukemia-free survival; MAC, myeloablative conditioning regimen; MMUD, mismatched unrelated donor; MRD, matched related donor; MUD, matched unrelated donor; NRM, nonrelapse mortality; OS, overall survival; PBSC, peripheral blood stem cells; RI, relapse incidence; RIC, reduced intensity conditioning regimen; sUCB, single umbilical cord blood; TBI, total body irradiation; TCF, total body irradiation, fludarabine, cyclophosphamide; UBM, unrelated bone marrow; UCBT, umbilical cord blood transplantation; UD, unrelated donor.