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Alternative donor transplantation after reduced intensity conditioning: results of parallel phase 2 trials using partially HLA-mismatched related bone marrow or unrelated double umbilical cord blood grafts.

TitleAlternative donor transplantation after reduced intensity conditioning: results of parallel phase 2 trials using partially HLA-mismatched related bone marrow or unrelated double umbilical cord blood grafts.
Publication TypeJournal Article
Year of Publication2011
AuthorsBrunstein, CG, Fuchs, EJ, Carter, SL, Karanes, C, Costa, LJ, Wu, J, Devine, SM, Wingard, JR, Aljitawi, OS, Cutler, CS, Jagasia, MH, Ballen, KK, Eapen, M, O'Donnell, PV
Corporate AuthorsBlood and Marrow Transplant Clinical Trials Network
JournalBlood
Volume118
Issue2
Pagination282-8
Date Published2011 Jul 14
ISSN1528-0020
KeywordsAdolescent, Adult, Aged, Algorithms, Bone Marrow Transplantation, Child, Family, Female, Fetal Blood, Graft Survival, Hematologic Neoplasms, Hematopoietic Stem Cell Transplantation, Histocompatibility Testing, HLA Antigens, Humans, Male, Middle Aged, Survival Analysis, Tissue Donors, Transplantation Conditioning, Transplantation, Homologous, Young Adult
Abstract

The Blood and Marrow Transplant Clinical Trials Network conducted 2 parallel multicenter phase 2 trials for individuals with leukemia or lymphoma and no suitable related donor. Reduced intensity conditioning (RIC) was used with either unrelated double umbilical cord blood (dUCB) or HLA-haploidentical related donor bone marrow (Haplo-marrow) transplantation. For both trials, the transplantation conditioning regimen incorporated cyclophosphamide, fludarabine, and 200 cGy of total body irradiation. The 1-year probabilities of overall and progression-free survival were 54% and 46%, respectively, after dUCB transplantation (n = 50) and 62% and 48%, respectively, after Haplo-marrow transplantation (n = 50). The day +56 cumulative incidence of neutrophil recovery was 94% after dUCB and 96% after Haplo-marrow transplantation. The 100-day cumulative incidence of grade II-IV acute GVHD was 40% after dUCB and 32% after Haplo-marrow transplantation. The 1-year cumulative incidences of nonrelapse mortality and relapse after dUCB transplantation were 24% and 31%, respectively, with corresponding results of 7% and 45%, respectively, after Haplo-marrow transplantation. These multicenter studies confirm the utility of dUCB and Haplo-marrow as alternative donor sources and set the stage for a multicenter randomized clinical trial to assess the relative efficacy of these 2 strategies. The trials are registered at www.clinicaltrials.gov under NCT00864227 (BMT CTN 0604) and NCT00849147 (BMT CTN 0603).

DOI10.1182/blood-2011-03-344853
Alternate JournalBlood
PubMed ID21527516
PubMed Central IDPMC3138683
Grant ListU10 HL069294 / HL / NHLBI NIH HHS / United States
U24 CA076518 / CA / NCI NIH HHS / United States
U10 HL069301 / HL / NHLBI NIH HHS / United States
U10 HL069330 / HL / NHLBI NIH HHS / United States
U10 HL069249 / HL / NHLBI NIH HHS / United States
U01 HL069294 / HL / NHLBI NIH HHS / United States
U10 HL069348 / HL / NHLBI NIH HHS / United States
U10 HL069290 / HL / NHLBI NIH HHS / United States
UO1-HL069294 / HL / NHLBI NIH HHS / United States
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