Cord blood transplantation is associated with good outcomes in secondary Acute Myeloid Leukaemia in first remission

Baron F, Labopin M, Ruggeri A, Volt F, Mohty M, Blaise D, Chevallier P, Sanz J, Fegueux N, Cornelissen JJ, Rambaldi A, Savani BN, Gluckman E, Nagler A (University of Liege, Liege; Belgium; Hematologie Clinique et Th erapie Cellulaire; Hospital Saint Antoine, Paris; France; IRCCS Bambino Gesu Children’s Hospital, Roma; Italy; Centre Scientifique de Monaco, Principaute de Monaco; Monaco; Universite Pierre & Marie Curie and INSERM UMRs U938, Paris; Institut Paoli Calmettes, Marseille; CHU of Nantes, Nantes; France; Hospital Universitario La Fe, Valencia; Spain; CHU Lapeyronie, Montpellier; France; Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam; The Netherlands; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo; Italy; Vanderbilt University Medical Center, Nashville, TN; USA; and The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan; Israel). Cord blood transplantation is associated with good outcomes in secondary Acute Myeloid Leukaemia in first remission. J Intern Med 2019; 285: 446–454. Background. We conducted a retrospective survey within the European Society for Blood and Marrow Transplantation (EBMT) registry to assess the outcomes of cord blood transplantation (CBT) in secondary acute myeloid leukaemia (sAML). Methods. Inclusion criteria consisted of ≥18 years of age, sAML, first CBT between 2002 and 2016, and either first complete remission (CR) or active disease at CBT. Results. One hundred forty-six patients met the study inclusion criteria. Status at transplantation was first CR (n = 97), primary refractory sAML (n = 30) or relapsed (n = 19) sAML. Neutrophil engraftment was achieved in 118 patients while the remaining 25 patients (17%) failed to engraft. This includes 13% of patients transplanted in first CR versus 30% of those transplanted with active disease (P = 0.008). Two-year incidences of relapse were 25% in first CR patients versus 36% in those with advanced disease (P = 0.06) while 2-year incidences of nonrelapse mortality were 35% and 49% (P = 0.03), respectively. At 2-year overall survival, leukaemia-free survival and graft-versus-host disease (GVHD)-free relapse-free survival were 42% vs. 19% (P < 0.001), 40% vs. 16% (P < 0.001), and 26% vs. 12% (P = 0.002) in first CR patients versus those with advanced disease, respectively. Conclusions. We report here the first study of CBT in a large cohort of sAML patients. Main observation was that CBT rescued approximately 40% of patients with sAML in first CR.

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