CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS Unrelated cord blood transplantation for childhood acute myeloid leukemia: a Eurocord Group analysis

Results of unrelated cord blood transplan-tation (UCBT) in childhood acute myeloid leukemia (AML) have not been previously reported. We analyzed 95 children receiv-ing UCB transplants for AML (20 in first complete remission [CR1], 47 in CR2, and 28 in more advanced stage). Poor progno-sis cytogenetic abnormalities were identi-fied in 29 cases. Most patients received a 1 or 2 HLA antigens–mismatched UCB transplants. The median number of col-lected nucleated cells (NCs) was 5.2 107/ kg. Cumulative incidence (CI) of neutro-phil recovery was 78 % 4%, acute graft-versus-host disease (GVHD) was 35% 5%, and 100-day transplantation-related mortal-ity (TRM) was 20 % 4%. In multivariable analysis, a collected NC dose higher than 5.2 107/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 leukemia-free survival (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 simi-lar LFS compared with 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 com-pared with 50 % 12 % in later relapses). We conclude that UCBT is a therapeutic option for children with very poor-prognosis AML and who lack an HLA-identical sibling. (Blood. 2003;102