Introduction
Methods
Study design and data collection
Ethics approval and consent to participate
Statistical analysis
Data sharing statement
Results
Patient, transplant, and disease characteristics
MMUD (N = 280) | CBT (N = 902) | p value | |
---|---|---|---|
Follow-up (reverse KM, months) | |||
Median (IQR) | 19.1 (11.4–36.7) | 46.8 (22.6–72.6) | < 0.001 |
Patient age (years) | |||
Median (min–max) [IQR] | 52.1 (18.2–75.6) [39.9–61.2] | 50.5 (18.1–73.2) [38.4–60.3] | 0.087 |
Year transplant | |||
Median (min–max) [IQR] | 2017 (2010–2019) | 2013 (2010–2019) | < 0.001 |
Cytogenetics risk groupa | |||
Good risk | 18 (6.4%) | 50 (5.5%) | 0.001 |
Intermediate risk | 148 (52.9%) | 366 (40.6%) | |
Adverse risk | 40 (14.3%) | 144 (16%) | |
Unknown risk | 74 (26.4%) | 342 (37.9%) | |
Disease status at transplantation | |||
CR1 | 179 (63.9%) | 522 (57.9%) | 0.023 |
CR2 + | 49 (17.5%) | 230 (25.5%) | |
Advanced | 52 (18.6%) | 150 (16.6%) | |
Patient gender | |||
Male | 163 (58.2%) | 430 (47.7%) | 0.002 |
Donor gender | |||
Male | 187 (68.2%) | 421 (50%) | < 0.001 |
Missing | 6 | 60 | |
Female donor to male recipient | |||
35 (12.7%) | 194 (22.2%) | < 0.001 | |
Missing | 5 | 29 | |
HCT-CI | |||
0 | 125 (59%) | 294 (57.3%) | 0.073 |
1 or 2 | 32 (15.1%) | 112 (21.8%) | |
≥ 3 | 55 (25.9%) | 107 (20.9%) | |
Missing | 68 | 389 | |
KPS score | |||
≥ 90 | 76 (27.1%) | 210 (23.3%) | 0.19 |
Patient CMV serostatus: positive | |||
Positive | 201 (73.6%) | 587 (66.9%) | 0.036 |
Missing | 7 | 24 | |
Donor CMV serostatus: positive | |||
Positive | 127 (45.8%) | 260 (35.2%) | 0.002 |
Missing | 3 | 163 | |
Graft source | |||
BM—19 (6.8%) | Single unit—408 (45.2%) | ||
PBSC—261 (93.2%) | Double unit—494 (54.8%) | ||
Conditioning regimen intensity | |||
MAC | 141 (50.4%) | 416 (46.1%) | 0.21 |
RIC | 139 (49.6%) | 486 (53.9%) | |
Type of conditioning regimen | |||
BuCy | 14 (5%) | 23 (2.5%) | < 0.001 |
BuFlu | 116 (41.4%) | 14 (1.6%) | |
TBF | 45 (16.1%) | 263 (29.2%) | |
TBI-based | 38 (13.6%) | 522 (57.9%) | |
Other | 67 (23.9%) | 80 (8.9%) | |
GVHD prophylaxisb | |||
csa + mmf | 111 (39.6%) | 638 (70.7%) | |
tacro + mmf | 51 (18.2%) | 22 (2.4%) | |
csa + mtx | 10 (3.6%) | 35 (3.9%) | |
csa | 34 (12.1%) | 183 (20.3%) | |
tacro | 24 (8.6%) | 2 (0.2%) | |
siro + mmf | 14 (5%) | 8 (0.9%) | |
other | 36 (12.9%) | 14 (1.6%) |
Engraftment
GVHD
Variable | Grade II–IV, acute GVHD | Chronic GVHD | Relapse | NRM | LFS | OS | GRFS | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | |
Donor source | ||||||||||||||
MMUD | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |||||||
CBT | 1.32 (1–1.74) | 0.052 | 0.94 (0.68–1.3) | 0.69 | 1.35 (1–1.83) | 0.05 | 2.09 (1.46–2.99) | < 0.0001 | 1.68 (1.34–2.12) | < 0.0001 | 1.7 (1.33–2.17) | < 0.0001 | 1.49 (1.21–1.83) | 0.0002 |
Patient age (per 10 years) | 1.11 (1.02–1.21) | 0.02 | 1.06 (0.96–1.17) | 0.24 | 0.99 (0.9–1.08) | 0.81 | 1.31 (1.18–1.45) | < 0.001 | 1.12 (1.05–1.2) | < 0.001 | 1.19 (1.11–1.28) | < 0.001 | 1.07 (1.01–1.14) | 0.02 |
Pre-HCT disease status | ||||||||||||||
CR1 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |||||||
CR2 | 1.05 (0.81–1.35) | 0.72 | 1.08 (0.8–1.45) | 0.63 | 1.07 (0.78–1.48) | 0.67 | 1.3 (0.97–1.74) | 0.08 | 1.2 (0.97–1.48) | 0.10 | 1.26 (1.01–1.58) | 0.04 | 1.14 (0.94–1.38) | 0.20 |
Advanced | 0.78 (0.57–1.08) | 0.13 | 0.95 (0.61–1.5) | 0.84 | 2.89 (2.19–3.83) | < 0.001 | 2.03 (1.47–2.8) | < 0.001 | 2.42 (1.96–2.99) | < 0.001 | 2.57 (2.07–3.21) | < 0.001 | 1.81 (1.48–2.21) | < 0.001 |
Cytogenetics | ||||||||||||||
Good risk | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |||||||
Intermediate risk | 1.22 (0.75–2) | 0.42 | 0.75 (0.45–1.24) | 0.26 | 1.59 (0.77–3.31) | 0.21 | 0.81 (0.48–1.35) | 0.41 | 1.09 (0.72–1.65) | 0.69 | 1.07 (0.69–1.66) | 0.75 | 0.94 (0.66–1.34) | 0.73 |
Adverse risk | 1.37 (0.8–2.34) | 0.25 | 0.69 (0.37–1.26) | 0.22 | 3.78 (1.79–7.98) | < 0.001 | 0.75 (0.41–1.36) | 0.34 | 1.74 (1.12–2.71) | 0.01 | 1.48 (0.93–2.36) | 0.10 | 1.36 (0.92–1.99) | 0.12 |
Unknown risk | 1.32 (0.79–2.19) | 0.29 | 0.88 (0.52–1.5) | 0.64 | 1.92 (0.92–4) | 0.08 | 0.85 (0.5–1.44) | 0.54 | 1.23 (0.81–1.88) | 0.33 | 1.2 (0.77–1.87) | 0.42 | 1.18 (0.82–1.7) | 0.36 |
Donor gender | ||||||||||||||
Male donor | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |||||||
Female donor | 0.82 (0.67–1.01) | 0.06 | 0.9 (0.7–1.15) | 0.40 | 0.94 (0.74–1.2) | 0.62 | 0.87 (0.69–1.11) | 0.26 | 0.9 (0.76–1.06) | 0.22 | 0.91 (0.76–1.08) | 0.29 | 0.83 (0.71–0.97) | 0.02 |
Conditioning regimen | ||||||||||||||
MAC | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | |||||||
RIC | 0.89 (0.69–1.14) | 0.34 | 0.86 (0.64–1.16) | 0.33 | 1.27 (0.97–1.64) | 0.08 | 0.6 (0.46–0.8) | < 0.001 | 0.86 (0.71–1.03) | 0.10 | 0.79 (0.65–0.97) | 0.02 | 0.85 (0.71–1.01) | 0.06 |
KPS ≥ 90 | 0.74 (0.58–0.94) | 0.02 | 1.19 (0.86–1.64) | 0.30 | 0.95 (0.72–1.24) | 0.69 | 0.8 (0.6–1.05) | 0.10 | 0.87 (0.72–1.05) | 0.16 | 0.86 (0.7–1.05) | 0.15 | 0.85 (0.71–1.02) | 0.09 |
Centre (frailty) | < 0.001 | < 0.001 | 0.24 | 0.03 | 0.30 | 0.18 | 0.10 |
Relapse, NRM, and survival
Matched-pair analysis
Toxicity
Etiology | MMUD (N = 84) | Cord blood transplant (N = 441) |
---|---|---|
Original disease | 30 (36.1%) | 155 (36%) |
Infection | 20 (24.1%) | 133 (30.9%) |
Graft-versus-host disease | 12 (14.5%) | 70 (16.2%) |
Cardiac toxicity | 1 (1.2%) | 1 (0.2%) |
Hemorrhage | 1 (1.2%) | 10 (2.3%) |
Graft failure/rejection | 0 (0%) | 3 (0.7%) |
Veno-occlusive disease | 3 (3.6%) | 9 (2.1%) |
Interstitial pneumonitis | 6 (7.2%) | 13 (3%) |
Lymphoproliferative disorder | 0 (0%) | 5 (1.2%) |
Second malignancy | 1 (1.2%) | 8 (1.9%) |
Multiorgan failure | 6 (7.2%) | 11 (2.6%) |
Other transplant related | 3 (3.6%) | 11 (2.6%) |
Missing cause of death | 1 | 12 |