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Prepublished online as a Blood First Edition Paper on August 14, 2003; DOI 10.1182/blood-2003-04-1288.
Submitted April 24, 2003
Accepted August 4, 2003
Unrelated cord blood transplantation for childhood acute myeloid leukemia: a Eurocord group analysis
Gerard Michel, Vanderson Rocha, Sylvie Chevret, William Arcese, Kah-Wah Chan, Alexandra Filipovich, Tsuneo A Takahashi, Marcus Vowels, Juan Ortega, Pierre Bordigoni, Peter J Shaw, Isaac Yaniv, Alexandra Machado, Pedro Pimentel, Franca Fagioli, Amparo Verdeguer, Jean-Pierre Jouet, Blanca Diez, Euripedes Ferreira, Ricardo Pasquini, Joseph Rosenthal, Eric Sievers, Chiara Messina, Anna Paola Iori, Federico Garnier, Irina Ionescu, Franco Locatelli, and Eliane Gluckman*
Department of Medicine, University of Marseille, Marseille, France
Eurocord Office, Paris, France
Department of Biostatistics, St. Louis Hospital, University of Paris 7, Paris, France
Department of Hematology, University La Sapienza, Rome, Italy
MD Anderson Cancer Center, Houston, TX, USA
Children's Hospital Medical Center, Cincinnati, OH, USA
Tokyo Cord Blood Bank, Tokyo, Japan
Sydney Children's Hospital, Sydney, Australia
Hospital Infantil Vall d'Hebron, Barcelona, Spain
Hopital d'Enfants, Nancy, France
The New Children's Hospital, Sydney, Australia
Schneider Children's Hospital, Petach-Tikva, Israel
Inst Portugues de Oncologia, Lisboa, Portugal
Inst Portugus de Oncologia, Porto, Portugal
Ospedale Regine Margherita, Torino, Italy
Hospital Infantil La Fe, Valencia, Spain
Claude Huriez Hospital, Lille, France
Fleni, Buenos Aires, Argentina
Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Hosptal de Clinicas, Curitiba, Brazil
City of Hope Medical School, Duarte, CA, USA
FHCRC, Seattle, WA, USA
Clinica oncoematologica peditrica, Padova, Italy
Oncoematologia Pediatrica, IRCCS Policlinico San Matteo, Pavia, Italy
* Corresponding author; email: eliane.gluckman{at}sls.ap-ho.
Results of unrelated cord blood transplantation (UCBT) in childhood acute myeloid leukemia (AML) have not been previously reported. We analyzed 95 children receiving UCBT for AML (20 in CR1, 47 in CR2 and 28 in more advanced stage). Poor prognosis cytogenetic abnormalities were identified in 29 cases. Most patients received a 1 or 2 HLA antigens mismatched UCBT. The median number of collected nucleated cells (NC) was 5.2x107/kg. Cumulative incidence (CI) of neutrophil recovery was 78±4%, acute graft versus host disease (GvHD) was 35±5% and 100-day transplant-related mortality (TRM) was 20±4%. In multivariable analysis, a collected NC dose higher than 5.2x107/kg was associated with a lower 100-day TRM. The 2-year CI of relapse was 29±5% and was associated with disease status. The 2-year LFS was 42±5%, (59±11 % in CR1, 50±8% in CR2, and 21±9% for children not in CR). Children with poor prognosis cytogenetic features had similar LFS compared to other patients (44±11 % vs 40±8 %). In CR2, LFS was not influenced by the length of CR1 (53±11% in CR1<9.5 months compared to 50±12% in later relapses). We conclude that UCBT is a good therapeutic for children with very poor prognosis AML and who lack an HLA-identical sibling.
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