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

Claudio G. Brunstein, Ephraim J. Fuchs, Shelly L. Carter, Chatchada Karanes, Luciano J. Costa, Juan Wu, Steven M. Devine, John R. Wingard, Omar S. Aljitawi, Corey S. Cutler, Madan H. Jagasia, Karen K. Ballen, Mary Eapen, Paul V. O'Donnell

Research output: Contribution to journalArticle

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 non-relapse mortality and relapse after dUCB transplantation were 24% and 31%, respectively, with corresponding results of 7% and 45%, respectively, after Haplo-marrow transplantation. These multi-center studies confirm the utility of dUCB and Haplo-marrow as alternative donor sources and set the stage for a multi-center randomized clinical trial to assess the relative efficacy of these 2 strategies. The trials are registered at www.clinical-trials.gov under NCT00864227 (BMT CTN 0604) and NCT00849147 (BMT CTN 0603).

Original languageEnglish (US)
Pages (from-to)282-288
Number of pages7
JournalBlood
Volume118
Issue number2
DOIs
StatePublished - Jul 14 2011

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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    Brunstein, C. G., Fuchs, E. J., Carter, S. L., Karanes, C., Costa, L. J., Wu, J., Devine, S. M., Wingard, J. R., Aljitawi, O. S., Cutler, C. S., Jagasia, M. H., Ballen, K. K., Eapen, M., & O'Donnell, P. V. (2011). 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. Blood, 118(2), 282-288. https://doi.org/10.1182/blood-2011-03-344853