Long-Term Outcomes of TBI-Based Myeloablative SCT In 292 Consecutive Adults with Ph-Negative ALL: Similar Outcomes for Transplantation Using Related Donor, Well-Matched Unrelated Donor, or Partially Matched Unrelated Donor Sources

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2355-2355
Author(s):  
Seok Lee ◽  
Seung-Ah Yahng ◽  
Sung-Eun Lee ◽  
Byung-Sik Cho ◽  
Ki-Seong Eom ◽  
...  
Keyword(s):  
High Risk ◽  
Cumulative Incidence ◽  
Unrelated Donor ◽  
Long Term Outcomes ◽  
Matched Unrelated Donor ◽  
No Donor ◽  
Risk Patients ◽  
Related Donor ◽  
Standard Risk

Abstract Abstract 2355 Background: The graft-versus-leukemia effect in adult acute lymphoblastic leukemia (ALL) has now been definitely confirmed from the ‘matched related donor (RD) versus no donor' comparisons. However, no definite conclusions can be extracted from these data as to whether or not there is a survival advantage to RD-stem cell transplantation (SCT) over other therapeutic modalities for both high-risk and standard-risk patients with Philadelphia (Ph)-negative ALL. In addition, ‘RD versus no donor' approach is becoming outmoded, as in many studies those previously in a ‘no donor' category are now undergoing unrelated donor (URD)-SCT. Aims: We report long-term outcomes of total body irradiation-based myeloablative SCT in 292 consecutive adults with Ph-negative ALL who received transplants at our center between 1995 and 2008 (median follow-up of survivors, 85 months). This study focused on following questions: (1) How different are the outcomes of SCT according to the donor sources? (2) Which factors are important to determination of transplantation outcome? (3) Which URD should be chosen? (4) Is there a role of autologous (AUTO)-SCT plus maintenance chemotherapy? Methods: Median age was 25 years (range, 15–63 years). Overall, 237 (81.2%) of 292 patients had one or more high-risk features, including adverse cytogenetics [t(4;11), t(8;14), complex (>=5 abnormalities), Ho-Tr], older age (>=35 years), high leukocyte counts (>=30×109/L for B-ALL, >=100×109/L for T-ALL), or delayed first complete remission (CR1; >28 days). Two hundred and forty-one patients (82.5%) were transplanted in CR1; 22 (7.6%) in CR2; and 29 (9.9%) in advanced status. URD sources were classified as well-matched (WM), partially matched (PM), and mismatched (MM) based on a new proposed guideline from the NMDP-CIBMTR. Donor sources were RD (n=132), WM-URD (n=30), PM-URD (n=19), MM-URD (n=19), and AUTO (n=92). All patients and donors provided written informed consent, and the treatment protocol was approved by the institutional review board of The Catholic University of Korea. Results: Cumulative incidence of relapse at 5 years was 48.5% for AUTO versus 32.6% for RD, 19.4% for WM-URD, 32.3% for PM-URD, and 51.0% for MM-URD (RR, 2.70; 95% CI, 1.65 to 4.42; p<0.001). In multivariate analyses, other factors associated with higher relapse risk included transplantation in CR2 or later (p<0.001), T-lineage ALL (p=0.020), and adverse cytogenetics (p=0.038). Cumulative incidence of non-relapse mortality (NRM) at 5 years was 40.5% for MM-URD versus 19.6% for SD, 20.3% for WM-URD, 15.8% for PM-URD, and 9.8% for AUTO (RR, 3.09; 95% CI, 1.32 to 7.25; p=0.010). Patients older than 35 years had higher NRM (p=0.007). As a result, disease-free survival (DFS) at 5 years was inferior using AUTO (46.1%; RR, 1.69; 95% CI, 1.14 to 2.51; p=0.010) or MM-URD (26.3%; RR, 2.03; 95% CI, 1.05 to 3.95; p=0.036), compared to RD sources, while DFS from all other donor sources was approximately equivalent (53.5% for RD, 63.3% for WM-URD, and 57.0% for PM-URD). Transplantation in CR2 or later (p<0.001), older age (p=0.020), and adverse cytogenetics (p=0.041) were associated with poorer DFS. In a pairwise comparison of outcomes between RD-SCT and AUTO-SCT for patients in CR1, the inferiority of AUTO-SCT was observed, particularly in high-risk patients. Conversely, in standard-risk patients, AUTO-SCT yielded comparable outcomes to RD-SCT. Summary/Conclusions: Our long-term data suggest that outcomes are similar for transplantation using SD, WM-URD, or PM-URD sources, and these may be considered the best donor sources for adults with Ph-negative ALL, especially for those with high-risk features. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Who Is the Better Donor for Young Hematopoietic Transplant Recipients without Siblings: An Older-Aged Haploidentical Parental Donor or a Young Unrelated Donor?

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2290-2290
Author(s):  
Mingming Zhang ◽  
Yi Luo ◽  
Yamin Tan ◽  
Jimin Shi ◽  
Weiyan Zheng ◽  
...  
Keyword(s):  
High Risk ◽  
Median Time ◽  
Unrelated Donor ◽  
Donor Age ◽  
Long Term Outcomes ◽  
Platelet Recovery ◽  
Risk Patients ◽  
To Receive ◽  
Standard Risk

Abstract Introduction: Hematopoietic stem cell transplant (HSCT) outcomes from unrelated donor (URD) and haploidentical donor were very close in recent years, and both could be alternative donors for recipients without siblings. But when considering donor age, especially for young recipients (≤30 years) without siblings, whether outcomes can be improved with a young URD rather than older-aged haploidentical parental donors (HPD) is still unknown. Methods: Between 2008 and 2014, a total of 156 young adult patients with hematological malignancies without sibling donors were assigned to receive URD or HPD HSCT in our center. The strategy of donor selection between URD and HPD was as follows: If an HLA suitably matched URD (≥8 of 10 matching HLA-A, -B, -C, -DRB1, and -DQB1 allele loci and ≥5 of 6 matching HLA-A, -B, and -DRB1 antigen loci) was available, patients were assigned to undergo URD-HSCT. If an HLA suitably matched URD was unavailable, patients were assigned to receive HPD-HSCT. Among them, 10 recipients received HSCT from URDs older than 40 years were further excluded. The transplant procedure had been reported previously (Yi Luo et. al. Blood 2014). Briefly, all patients received myeloablative conditioning involving BuCy without total body irradiation. The GVHD prophylaxis consisted of cyclosporin A, methotrexate, and low-dose mycophenolate mofetil. Grafts were granulocyte-colony stimulating factor mobilized peripheral blood stem cells without ex vivo T-cell depletion. Results: The median age of the finally included 146 young recipients was 21 years (range, 15-30 years). Of whom, 67 received HSCT from HPDs and 79 received HSCT from URDs.The median donor age of the HPDs was 46 years (range, 40-53 years), in contrast to 28 years (range, 20-39 years) of the URDs. Engraftment All patients achieved myeloid recovery. The median time and the cumulative 15-day incidences of myeloid engraftment were 12 days (range, 8-16 days) and 97.4% in the URD cohort, and 13 days (range, 8-21 days) and 77.6% in the HPD cohort, respectively. Myeloid recovery in the HPD cohort was significantly delayed compared with URD cohort (P<0.001). Two patients in the HPD cohort experienced primary platelet engraftment failure. The median time and the cumulative 30-day incidences of platelet engraftment were 13 days (range, 6-24 days) and 100% in URDs, and 15 days (range, 6-30 days) and 97.0% in HPDs, respectively. Patients receiving HSCT from HPDs experienced significantly delayed platelet recovery compared with those receiving HSCT from URDs (P<0.001). aGVHD The incidences of grades II-IV aGVHD were 45.5% in the URD cohort and 47.8% in the HPD cohort (P=0.78), respectively. The incidences of grades III-IV aGVHD were 14.3% in the URD cohort and 17.9% in the HPD cohort (P=0.55), respectively. Long-term Outcomes There was a trend of higher 5-year overall survival (OS) and relapse free survival (RFS) rates for patients transplanted from young URDs in comparison with HPDs (OS: 64.4% vs 59.6% (P=0.23) and RFS: 63.2% vs 49.6%; (P=0.20)),respectively. The relapse rate and non-relapse mortality (NRM) rate were comparable between two cohorts. For standard risk patients, a significantly higher 5-year OS and RFS rate were observed for patients transplanted from young URDs compared with HPDs (OS: 76.3% vs 52.7% (P=0.03) and RFS: 73.2% vs 53.8%; (P=0.04)), respectively. The significantly lower survival rate in the HPD cohort to some extent could be explained by the higher NRM rate in the HPD cohort (HPD 30.8% vs URD 13.9%, P=0.07). While for high risk patients, long-term outcomes were comparable between two cohorts. Conclusion: These data favor a young URD over an older-aged HPD for young recipients without siblings in standard risk; while for those in high risk, transplant outcomes were comparable between a young URD and an old-aged HPD. Moreover, myeloid and platelet recovery were significantly delayed in HPD-HSCT compared with URD-HSCT. Disclosures No relevant conflicts of interest to declare.

scholarly journals Long-Term Follow-Up Results of Lenalidomide, Bortezomib, and Dexamethasone Induction Therapy and Risk-Adapted Maintenance Approach in Newly Diagnosed Multiple Myeloma

2020 ◽  
Vol 38 (17) ◽  
pp. 1928-1937 ◽  
Author(s):  
Nisha S. Joseph ◽  
Jonathan L. Kaufman ◽  
Madhav V. Dhodapkar ◽  
Craig C. Hofmeister ◽  
Dhwani K. Almaula ◽  
...  
Keyword(s):  
High Risk ◽  
Induction Therapy ◽  
Newly Diagnosed ◽  
Long Term Outcomes ◽  
Entire Cohort ◽  
Induction Regimen ◽  
Risk Patients ◽  
Standard Risk

PURPOSE The combination of lenalidomide, bortezomib, and dexamethasone (RVD) is a highly effective and convenient induction regimen for both transplantation-eligible and -ineligible patients with myeloma. Here, we present the largest cohort of patients consecutively treated with RVD induction therapy followed by risk-adapted maintenance therapy with the longest follow-up and important information on long-term outcomes. PATIENTS AND METHODS We describe 1,000 consecutive patients with newly diagnosed myeloma treated with RVD induction therapy from January 2007 until August 2016. Demographic and clinical characteristics and outcomes data were obtained from our institutional review board–approved myeloma database. Responses and progression were evaluated per International Myeloma Working Group Uniform Response Criteria. RESULTS The overall response rate was 97.1% after induction therapy and 98.5% after transplantation, with 89.9% of patients achieving a very good partial response (VGPR) or better and 33.3% achieving stringent complete response after transplantation at a median follow-up time of 67 months. The estimated median progression-free survival time was 65 months (95% CI, 58.7 to 71.3 months) for the entire cohort, 40.3 months (95% CI, 33.5 to 47 months) for high-risk patients, and 76.5 months (95% CI, 66.9 to 86.2 months) for standard-risk patients. The median overall survival (OS) time for the entire cohort was 126.6 months (95% CI, 113.3 to 139.8 months). The median OS for high-risk patients was 78.2 months (95% CI, 62.2 to 94.2 months), whereas it has not been reached for standard-risk patients. Five-year OS rates for high-risk and standard-risk patients were 57% and 81%, respectively, and the 10-year OS rates were 29% and 58%, respectively. CONCLUSION RVD is an induction regimen that delivers high response rates (VGPR or better) in close to 90% of patients after transplantation, and risk-adapted maintenance can deliver unprecedented long-term outcomes. This study includes the largest cohort of patients treated with RVD reported to date with long follow-up and demonstrates the ability of 3-drug induction regimens in patients with newly diagnosed multiple myeloma to result in a substantial survival benefit.

Temporal trends in late-onset morbidity and mortality after medulloblastoma diagnosed across three decades: A report from the Childhood Cancer Survivor Study (CCSS).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10516-10516 ◽  
Author(s):  
Ralph Salloum ◽  
Yan Chen ◽  
Yutaka Yasui ◽  
Roger Packer ◽  
Wendy M. Leisenring ◽  
...  
Keyword(s):  
Special Education ◽  
High Risk ◽  
Cumulative Incidence ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
Long Term Outcomes ◽  
Late Mortality ◽  
Life Threatening ◽  
Standard Risk

10516 Background: Therapy for medulloblastoma and primitive neuroectodermal tumor has evolved from surgery and adjuvant radiotherapy to risk-adapted multimodal regimens. The impact of these changes in treatment on long-term outcomes remains unknown. Methods: Cumulative incidence of late mortality ( > 5 years from diagnosis), subsequent malignant neoplasms (SMN), chronic health conditions and psychosocial functioning were evaluated among 5-year survivors in CCSS diagnosed between 1970 and 1999. Survivors were stratified according to treatment decade (1970s, 1980s, 1990s) and treatment exposure (surgery + craniospinal irradiation [CSI] ≥30 Gy, no chemotherapy; surgery + CSI ≥30 Gy + chemotherapy [high-risk therapy], surgery + CSI ˂30 Gy + chemotherapy [standard-risk therapy]). Rate ratios (RRs), odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for long-term outcomes among treatment eras and exposure groups using multivariable piecewise-exponential models. Results: Among 1,380 eligible survivors (median [range] age 29 [6-20] years; 21.4 [5-44] years from diagnosis), the 15-year cumulative incidence of all-cause (21.9% 1970s vs. 12.8% 1990s; p = 0.003) and recurrence-related (16.2% vs 9.6%, p = 0.03) late mortality decreased with no reduction in mortality attributable to late effects of therapy including SMN. Among 959 participants, the incidence of SMN did not decrease by era or by treatment group. However, survivors treated in the 1990s had an increased cumulative incidence of severe, life-threatening and fatal health conditions (16.9% 1970s vs 25.4% 1990s; p = 0.03), and were more likely to develop multiple severe or life-threatening health conditions, RR = 2.98 (95% CI, 1.10-8.07). Survivors of standard-risk therapy were less likely to use special education services than high-risk therapy patients, OR = 0.51 (95% CI, 0.33-0.78). Conclusions: Historical changes in therapy have improved 5-year survival, reduced risk of late mortality due to disease recurrence, and reduced special education utilization, at the cost of increased risk for multiple, severe and life-threatening chronic health conditions.

Laparoscopic Sleeve Gastrectomy for High-Risk Patients in a Monocentric Series: Long-Term Outcomes and Predictors of Success

2019 ◽  
Vol 29 (11) ◽  
pp. 3629-3637 ◽  
Author(s):  
Aurora Gil–Rendo ◽  
José Ramón Muñoz-Rodríguez ◽  
Francisco Domper Bardají ◽  
Bruno Menchén Trujillo ◽  
Fernando Martínez-de Paz ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
High Risk ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Predictors Of Success ◽  
Long Term Outcomes ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Strong Predictors of Chromosomal Aberrations and Myeloid Neoplasia Following Immunosuppression Therapy for Severe Aplastic Anemia: A Retrospective Cohort Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 601-601
Author(s):  
Emma M. Groarke ◽  
Bhavisha A. Patel ◽  
Ruba Shalhoub ◽  
Fernanda Gutierrez-Rodrigues ◽  
Parth Desai ◽  
...  
Keyword(s):  
High Risk ◽  
Clonal Evolution ◽  
Low Risk ◽  
Competing Risk ◽  
Long Term Outcomes ◽  
Risk Patients ◽  
Risk Evolution ◽  
Pre Treatment ◽  
Myeloid Neoplasia

Abstract Introduction: Immune aplastic anemia (AA) is effectively treated with either immunosuppressive treatment (IST) or allogeneic hematopoietic stem cell transplant (HSCT). Clonal evolution remains the most feared long-term complication after IST. We investigated predictor factors, genetic characteristics, and long-term outcomes of patients who developed either secondary myeloid neoplasia or isolated chromosomal abnormalities without morphologic dysplasia after immunosuppression. Methods: All patients with severe AA treated at the NIH Clinical Center with IST from 1989-2020 who underwent clonal evolution were categorized as "high-risk" (overt myeloid neoplasia, or isolated chromosome 7 abnormality / complex cytogenetics) or "low-risk" (isolated chromosome abnormalities without overt myeloid neoplasia or dysplasia; isolated chromosome 7 abnormality or complex cytogenetics were characterized as high-risk). Univariable analysis was performed using the Fine-Gray competing risk regression model using death as a competing risk to determine predictors of clonal evolution. Classification and regression tree analysis of time to clonal evolution was performed on continuous baseline variables to partition the data based on the best categorical cutoff. Long term outcomes assessed included overall survival (OS) and HSCT. Error corrected next-generation sequencing (ECS) was used to assess for pathogenic somatic variants in known myeloid cancer genes in clonal evolvers both at time of evolution and in serial samples prior when available. Results: Of 659 patients with severe AA included in this study, 95 developed clonal evolution: 59 high-risk and 36 low-risk. Age &gt;48 years at diagnosis and pre-treatment ANC &gt;0.87x10 9/L were strong predictors of high-risk clonal evolution. High-risk clonal evolution was increased in patients aged &gt;48 years, with cumulative incidence (CI) of 13.9% by 5 years compared to patients aged &lt;48 years of 3.8% by 5 years (p&lt;0.001). Baseline ANC &gt;0.87 x10 9/L (independent of age) predicted an even higher risk of evolution; CI for high-risk evolution was 17% by 5 years (p&lt;0.001). Combined high ANC and older age (&gt;48 years) were prognostic of the greatest risk of high-risk evolution, with a hazard ratio (HR) of 5.51; conversely, ANC &lt;0.87 x10 9/L and age &lt;48 years was protective, with HR 0.32. High-risk clonal evolution was not significantly increased by use of eltrombopag with IST versus IST only (p=0.3), but there was an increase when all clonal evolution was considered (p=0.02). Overall survival in high-risk evolution was 35% at 5 years and in low-risk evolution was 84% (p&lt;0.001). Patients with high-risk evolution who underwent HSCT (n=26) had better OS compared to those treated with chemotherapy or supportive care (p=0.005). RUNX1 (13 variants in 8 [35%] patients) and ASXL1 (13 variants in 10 [43%] patients) were the most frequent mutated genes at time of clonal evolution in high-risk patients, and BCOR/L1 (14 variants in 8 [32%] patients) was the most frequently mutated in the low-risk group. Longitudinal data were available in five high-risk and eight low-risk patients. Three of five high-risk patients had acquisition or expansion of RUNX1 clones at evolution. Small RUNX1 variants were present in two patients as early as three years prior to high-risk evolution. Splicing factor genes and RUNX1 somatic variants were detected exclusively in the high-risk group; DNMT3A, BCOR/L1 and ASXL1 gene mutations were present in both groups. Conclusion: Age and pre-treatment ANC strongly predict high-risk clonal evolution in AA patients after IST and may be used determine at-risk patients for long term follow-up. Outcomes in patients with low-risk evolution are favorable but poor in high-risk evolution without HSCT. The clonal landscape differs between high-risk and low-risk evolution; MDS-associated genetic mutations are enriched in high-risk evolution, in particular RUNX1. Further study of the role of RUNX1 in high-risk clonal evolvers may give insight into leukemogenesis in AA. Figure 1: Cumulative incidence (CI) of clonal evolution since immunosuppression with death treated as competing risk. (A) CI for development of all clonal evolution in patients &gt;37 years (B) and high-risk clonal evolution in patients &gt;48 years (C) CI for development of all clonal evolution when baseline ANC &gt;0.87x10 9/L and (D) high-risk clonal evolution when baseline ANC &gt;0.87x10 9/L. Figure 1 Figure 1. Disclosures Young: Novartis: Research Funding.

scholarly journals Comparison of Outcomes of Unrelated BM and CB Transplants in Young Adult Leukemia Patients. Updated Results of Japanese Registration Study

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 45-45
Author(s):  
Seitaro Terakura ◽  
Yoshiko Atsuta ◽  
Nobuhiro Tsukada ◽  
Takeshi Kobayashi ◽  
Masatsugu Tanaka ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Risk Group ◽  
Unrelated Donor ◽  
Transplant Outcomes ◽  
First Choice ◽  
Significant Difference ◽  
Risk Patients ◽  
Standard Risk ◽  
Mismatch Effect

Abstract Background: Currently, among HLA-8/8, or 7/8 allele-matched unrelated donor (UD) and umbilical CBT (UCBT), HLA-8/8 allele-matched UD transplantation (UDT) showed superior overall survival (OS) to 7/8 allele-matched UDT and UCBT, while a similar OS has been demonstrated between the HLA-7/8 allele-matched UDT and the UCBT. It has been observed that recipients of CB had higher earlier mortality including graft-failure or severe infections. However, less graft-versus-host disease (GVHD) and associated complications brought less long-term mortality, which compensate the early deaths. Thus we hypothesized that UCBT may demonstrate comparable outcomes with 8/8 allele-matched UDT in updated long-term analyses. Methods: The purpose of the current study is to compare the transplant outcomes of 8/8 and 7/8 allele-matched BMT with those of CBT, and redefine the role of CBT. Because the most of UDT in Japan is still BM transplantation, we analyzed the transplant outcomes in younger adult patients (age, 16-50) receiving UCBT in comparison with those receiving 8/8, 7/8 and 6/8 allele-matched unrelated BMT (UBMT) for acute lymphocytic leukemia (ALL) and acute myeloid leukemia (AML) using a Japanese registry database (TRUMP data). Also we included 6 out of 6 HLA-allele data available UCBT so that we could analyze each allele-mismatch effect within UCBT group. Results: A total of 3,062 first transplants between 2001 and 2010 were included. [AML: 8/8 UBMT, 676; 7/8 UBMT, 455; 6/8 UBMT, 204; CB; 617][ALL: 8/8 UBMT, 418; 7/8 UBMT, 267; 6/8 UBMT, 120; CB, 305] For AML, CR1 and CR2 are defined as standard risk and others are as advanced risk. For ALL, CR1 is defined as standard risk and others are as advanced risk disease. Advanced risk patients were significantly more in the UCBT group. With adjusted analyses for AML, UCBT and 8/8 UBMT showed similar OS, while 7/8 and 6/8 UBMT showed inferior OS [8/8 UBMT as reference: CB; Hazard ratio (HR) =1.08 (95% confidence interval (95%CI), 0.91-1.29), p=0.37: 7/8 UBMT; HR = 1.27 (95%CI, 1.06-1.52), p=0.009: 6/8 UBMT; HR =1.33 (95%CI, 1.06-1.67), p=0.015]. The 4-year unadjusted OS was 65.9% (95% CI, 60.6-70.7) for 8/8 UBMT and 61.8% (95%CI, 55.0-67.9) for UCBT in standard risk patients, while 28.1% (95%CI, 21.6-34.9) for 8/8 UBMT and 30.3% (95%CI, 25.0-35.8) for UCBT in advanced risk patients. For ALL, there is no significant difference in OS among 4 groups in adjusted analyses. The 4-year unadjusted OS was 64.3% (95%CI, 57.3-70.5) for 8/8 UBMT and 65.7% (95%CI, 56.1-73.7) for UCBT in standard risk patients, while 28.5% (95%CI, 20.2-37.3) for 8/8 UBMT and 30.2% (95%CI, 21.6-39.2) for UCBT in advanced risk patients. There is no significant difference in the risk of relapse among 4 groups for both AML and ALL. Non-relapse mortality (NRM) in AML after UCBT was comparable with 8/8 UBMT, while 7/8 and 6/8 UBMT had higher NRM [CB; HR =1.12 (95%CI, 0.85-1.47), p=0.43: 7/8 UBMT; HR = 1.51 (95%CI, 1.16-1.96), p=0.002: 6/8 UBMT; HR =1.55 (95%CI, 1.12-2.16), p=0.009]. The 2-year unadjusted NRM of AML for 8/8, 7/8, 6/8 UBMT and UCBT was 16.5% (95%CI, 13.0-20.5), 24.2% (95%CI, 19.1-29.7), 26.0% (95%CI, 18.3-34.4) and 20.0% (95%CI, 15.2-25.3) in the standard risk group, respectively, while 21.4% (95%CI, 15.9-27.4), 30.7% (95%CI, 23.3-38.4), 26.7% (95%CI, 16.8-37.6) and 19.0% (95%CI, 15.0-23.5) in the advanced risk group respectively. For ALL, the adjusted NRM is not significantly different between 8/8, 7/8 UBMT and UCBT, although 6/8 UBMT alone demonstrated higher risk of NRM. To examine the allele-mismatch effect in UCBT group, we further compared OS/NRM of each allele-mismatch UCBT with UBMT in the cox's multivariate analysis [8/8-, 7/8-, 6/8-UBMT, 6/6-, 5/6-, 4/6-, 3/6-, 2/6- and 1/6-UCBT]. Each allele-mismatch UCBT group showed comparable HR with 8/8 UBMT group (Figure). There was no significant difference among each allele-mismatch group. Conclusion: These data suggest that CB may be the first choice alternative to 8/8 UBM for AML. For ALL, 8/8 UBM is the first choice, however, CBT will convey comparable outcomes with 7/8 UBMT. The survival after UCBT is approaching to that after 8/8 UBMT in recent years. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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