Intensified Myeloablative Conditioning Regimen without Antithymocytic (ATG) Results in Superior Patient Outcome Compared to Myeloablative Conditioning Regimen for Single-Unit Umbilical Cord Blood Transplantation in Hematological Malignancies

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5837-5837
Author(s):  
Zimin Sun ◽  
Huilan Liu ◽  
Yue Wu ◽  
Changcheng Zheng ◽  
Baolin Tang ◽  
...  
Keyword(s):  
Cord Blood ◽  
Cumulative Incidence ◽  
Single Unit ◽  
Hematological Malignancies ◽  
Cord Blood Transplantation ◽  
Conditioning Regimen ◽  
Myeloablative Conditioning ◽  
Blood Transplantation ◽  
Group A ◽  
Neutrophil Engraftment

Abstract The superiority and safety of strengthening conditioning regimen for single- unit unrelated cord blood transplantation (sUCBT) in hematological malignancies remain controversial. We retrospectively analyzed the clinical data of 251 hematological malignancies undergoing sUCBT from Apr 2000 to Dec 2014 at Department of hematology in Anhui Provincial Hospital. Out of the 251 patients, 216 received the intensified myeloablative conditioning regimen (IMCR), and 35 received the myeloablative conditioning regimen (MCR). We evaluated the effect of IMCR without using Antithymocyte globulin (ATG) on patient outcomes. The cumulative incidence of myeloid and platelet engraftment of the IMCR group was significantly higher than that in the MCR group (96.98% vs. 82.81%, 85.89% vs. 51.79%, P=0.000 and 0.003, respectively). Corresponding incidences of transplantation-related mortality (TRM) by 180 days in the IMCR group and the MCR group were 19.50% vs. 41.67% (P=0.003), respectively. There were no differences in the incidence of grade II to IV acute GVHD (aGVDH), grade III to IV aGVHD and 2-year cumulative incidence of relapse. Up to Dec. 2015, with a median follow-up of 30 months, the estimated 3-year overall survival and disease- free survival in the IMCR group were both significantly higher than that of the MCR group (64.8% vs. 35.5%, 61.6% vs. 35.5%, P=0.000 and 0.001, respectively). This study is the first to show the superiority of intensified myeloablative regimen to conventional myeloablative regimen.A large-scale prospective study was needed. (A) (B) Figure 1 The cumulative incidence of neutrophil and platelet engraftment of the IMCR group and MCR group. (A)The cumulative incidence of neutrophil engraftment of the IMCR group was predominantly higher than that in the MCR group(96.98% vs. 82.81%, P=0.000). (B)The cumulative incidence of platelet engraftment of the IMCR group was also higher than that in the MCR group(85.89% vs. 51.79%, P=0.003). Figure 1. The cumulative incidence of neutrophil and platelet engraftment of the IMCR group and MCR group. (A)The cumulative incidence of neutrophil engraftment of the IMCR group was predominantly higher than that in the MCR group(96.98% vs. 82.81%, P=0.000). (B)The cumulative incidence of platelet engraftment of the IMCR group was also higher than that in the MCR group(85.89% vs. 51.79%, P=0.003). Figure 2 Comparison of the incidence of 3-year OS between the IMCR group and the MCR group.The incidence of 3-year OS of the IMCR group is predominantly higher than that of the MCR group(62.4% vs. 35.5%,P=0.001). Figure 2. Comparison of the incidence of 3-year OS between the IMCR group and the MCR group.The incidence of 3-year OS of the IMCR group is predominantly higher than that of the MCR group(62.4% vs. 35.5%,P=0.001). Figure 3 Figure 3. Disclosures No relevant conflicts of interest to declare.

scholarly journals Cord Blood Units Containing Lower CD34+ Cells (0.5 - 1.0 x 105 /kg) Could be Alternative Donor Candidates for Single-Unit Cord Blood Transplantation for Adults: A Retrospective Study of 421 Patients in a Single Institute

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2089-2089
Author(s):  
Shinsuke Takagi ◽  
Mitsuhiro Yuasa ◽  
Naoyuki Uchida ◽  
Michiho Ebihara ◽  
Takashi Mitsuki ◽  
...  
Keyword(s):  
Cord Blood ◽  
Cumulative Incidence ◽  
Single Unit ◽  
Hematopoietic Cell Transplantation ◽  
Cord Blood Transplantation ◽  
Cell Dose ◽  
Cd34 Cells ◽  
Group A ◽  
Alternative Donor ◽  
Neutrophil Engraftment

Abstract BACKGROUND: Cord blood is an established alternative donor cell source for allogeneic hematopoietic cell transplantation. However, engraftment failure is still a major concern after transplantation, especially for patients transplanted lower doses of donor cells. Higher CD34+ cell dose leads to a secure and fast engraftment, and the units of cord blood which contain CD34+ cells of 1.0 - 1.7 x 105 /kg at freezing or 1.0 - 1.2 x 105 /kg at thawing are recommended (Thomas' Hematopoietic Cell Transplantation, 5th Edition). Actually, most adult patients cannot obtain such sufficient cell dose-containing cord bloods and the feasibility of single-unit cord blood transplantation (CBT) containing lower CD34+ cell dose than 1.0 x 105 /kg is unclear. METHODS: To investigate the lower threshold of CD34+ cell dose, we studied the patients who received single-unit CBT as the first transplantation between 2009 and 2017. The patients whose ECOG performance status was 0 or 1, and who do not have donor-specific anti-HLA antibody (DSA) were analyzed. Institutional review board of Toranomon Hospital approved the study (research number #1666). RESULTS: A total of 421 patients were studied. The median age and body weight of patients was 57 years (range, 16 - 74) and 56.4 kg (32.2 - 94.6), respectively. Myeloid diseases accounted for 78% of the patients, and 83% were not in remission. Myeloablative conditioning regimens were used in 80% of the patients. All patients used Tac (26%) or Tac plus MMF (74%) as GVHD prevention. The median numbers of total nucleated cells and CD34+ cells were 2.61 x107 /kg (range, 1.57 - 5.85) and 0.86 x 105 /kg (0.29 - 3.77) at freezing, respectively. The cumulative incidence of neutrophil engraftment was 90.7% at 60 days after transplantation (95% confidence interval, 87.5 - 93.1). The median day of neutrophil engraftment was day 21 (range, 5 - 45). Multivariate analysis identified higher CD34+ cell dose, less HLA mismatch, and lymphoid disease as significant favorable factors for neutrophil engraftment (p < 0.05), and CD34+ cell dose was most significant among the following pre-transplant factors (HR 1.57, p < 0.00001): age (≤ 57 vs. >57 years), body weight (≤ 56.4 vs. > 56.4 kg), ECOG performance status (0 vs. 1), disease (myeloid vs. lymphoid), disease status (in CR vs. not in CR), anti-HLA antibody (not DSA) (positive vs. negative), total nucleated cell dose (≤ 2.61 vs. > 2.61 x 107 /kg), CD34+ cell dose (≤ 0.86 vs. >0.86 x 105 /kg), HLA antigen match (≤4/6 vs. ≥5/6), ABO match (match vs. mismatch), sex match (match vs. mismatch), GVHD prevention (Tac vs. TAC plus MMF), and the intensity of conditioning regimen (MAC vs. RIC). Then, we compared the cumulative incidence of neutrophil engraftment between 4 groups as follows: 90.2% for group A (> 1.5 x 105 /kg, n = 41); 91.7% for group B (1.0 - 1.5 x 105 /kg, n = 109); 91.4% for group C (0.5 - 1.0 x 105 /kg, n = 255); 75.0% for group D (< 0.5 x 105 /kg, n = 16) (p < 0.01). The median day of neutrophil engraftment was faster for the patients transplanted more CD34+ cell doses: day 17 for group A; day 19 for B; day 21 for C; day 26.5 for D (p < 0.0001). Next, we focused on group C transplanted lower CD34+ cell dose than the recommendation (0.5 - 1.0 x 105 /kg, n = 255).The patients were divided into 5 groups according to their CD34+ cell doses, and we compared their cumulative incidence of neutrophil engraftment as follows: 96.0% for group C1 (0.9 - 1.0 x 105 /kg, n = 50); 89.7% for group C2 (0.8 - 0.9 x 105 /kg, n = 39); 88.1% for group C3 (0.7 - 0.8 x 105 /kg, n = 67); 92.2% for group C4 (0.6 - 0.7 x 105 /kg, n = 51); 91.7% for group C5 (0.5 - 0.6 x 105 /kg, n = 48) (p = 0.03). The median day of neutrophil engraftment was significantly faster for the patients transplanted more CD34+ cell dose: day 20 for group C1; day 21 for C2; day 21 for C3; day 23 for C4; day 24 for C5 (p < 0.01). Overall survival was not significantly different between group A vs. B vs. C vs. D, nor group C1 vs. C2 vs. C3 vs. C4 vs. C5, respectively. DISCUSSION & CONCLUSION: Significantly faster neutrophil engraftment was demonstrated for patients transplanted more CD34+ cells after single-unit CBT. On the other hand, the cumulative incidences of neutrophil engraftment at day 60 were comparable among the patients who used > 0.5 x 105 /kg of CD34+ cells to be around 90%. The cord blood units containing 0.5 - 1.0 x 105 /kg at freezing could be alternative donor candidates for cord blood selection, if delayed engraftment was clinically acceptable for recipients. Disclosures Yamamoto: Bristol-Myers Squibb: Honoraria.

scholarly journals Intensified Myeloablative Unrelated Cord Blood Transplantation for High-Risk or Advanced Hematological Malignancies: Experience at a Single-Institution in China

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1222-1222
Author(s):  
Zimin Sun ◽  
Huilan Liu ◽  
Baolin Tang ◽  
Xiaoyu Zhu ◽  
Wen Yao ◽  
...  
Keyword(s):  
Retrospective Study ◽  
High Risk ◽  
Cord Blood ◽  
Cumulative Incidence ◽  
Hematological Malignancies ◽  
Acute Gvhd ◽  
Cord Blood Transplantation ◽  
Blood Transplantation ◽  
Unrelated Cord Blood ◽  
Neutrophil Engraftment

Abstract Introduction : Unrelated cord blood transplantation (CBT) is one of the most promising curative treatment modalities for hematological malignancies. But the data was limited in China. This retrospective study evaluated the clinical outcomes of intensified myeloablative unrelated CBT for high-risk or advanced hematological malignancies in our single center. Patients and Methods: From September 2006 to December 2013, Total of 187 high-risk or advanced hematologic malignancies underwent intensified myeloablative unrelated CBT. All CBT patients received a myeloablative conditioning regimen of TBI/Ara-C/CY [total body irradiation (TBI, total 12 Gy, 4 fractions) (d-7, d-6) arabinoside cytarabine (Ara-C) (2.0g/m2 every 12h for 2 days) (d-5, d-4) and cyclophosphamide (CY, 60 mg/kg daily for 2 days) (d-3, d-2)] (age≥14 years or primary induction failure or no remission after relapse), or Fludarabine/BU/CY2 [fludarabine (Flu, 30mg/m2 daily for 4 days) (d-8~ -5), busulfan (0.8mg/kg every 6h for 4 days) (d-7~ -4) and CY (60 mg/kg daily for 2 days) (d-3, d-2)] (For lymphoid malignancies patients with age ＜14 years or prior radiotherapy which would presuppose a high risk of toxicity), or Ara-C/BU/CY2 [ Ara C (2.0g/m2 every 12h for 2 days) (d-9, d-8), (busulfan (0.8mg/kg every 6h for 4 days) (d-7~ -4) and CY (60 mg/kg daily for 2 days) (d-3, d-2)](for myeloid malignancies patients with age < 14 years or prior radiotherapy which would presuppose a high risk of toxicity), and G-CSF was given with 5 ug/kg daily by subcutaneous injection one day prior to Ara-C with 3 days. For GVHD prophylaxis, all patients were given a combination of cyclosporine and short-course mycophenolate mofetil, and no patient received antithymocyte globulin (ATG). Results: Total of 181 patients (97.3%) achieved neutrophil engraftment and platelet engraftment, and the median number of days was 18 days (range 12~37 days) and 37.5days (range 15~112 days), respectively. Total nucleated-cell dose (≥5.2×107 / kg) and total CD34+ cell dose (≥3.8×105 / kg) were the favorable factors predicting for a higher probability of neutrophil engraftment (p =0.012, 0.025). The cumulative incidence of pre-engraftment syndrome (PES) and day-100 grade Ⅱ-Ⅳ acute GVHD was 75.4% (95% CI, 65.2-84.2%) and 28.34% (95% CI, 28.13~28.55%), respectively. The cumulative incidence of grade Ⅱ-Ⅳ acute GVHD 100 days after transplantation was 32.6% (95% CI, 42.3-22.8%)in the PES group and 15.2% (95% CI, 8.3-22.6%) in the non-PES group (р=0.016). Multivariate analysis showed that BU/CY2 based conditioning and without PES were significant risk factors for graft failure [RR=2.34 (95% CI, 1.32- 6.12), p =0.015; RR=2.89 (95% CI, 1.25- 6.82), p =0.009]. The median follow-up time was 27（7~89）months. Transplant-related mortality at 180 days and relapse at 3 years after CBT was 24.9% (24.7~25.2%) and 14.7% (14.6~14.9%). Probabilities of 3-year overall survival (OS) and disease-free survival (DFS) were 61.2% (95% CI, 51.3%- 72.3%) and 58.6% (95% CI, 49.5%- 67.9%), respectively. For pediatric patients, 3-year OS and DFS were 66.2% (95% CI, 56.4%- 75.8%) and 64.8% (95% CI, 54.6%- 74.2%); for adult patients, 3-year OS and DFS were 54.5% (95% CI, 45.8%- 63.7%) and 50.3% (95% CI, 41.5%- 60.1%), respectively. Conclusions: To the best of our knowledge, this is the largest clinical study of unrelated CBT reported in China. This retrospective study indicates that intensified myeloablative CBT procedures are associated with significant favorable outcomes in survival advantage in high-risk or advanced hematological malignancies. Disclosures No relevant conflicts of interest to declare.

Reduced-Intensity Conditioning Regimen without Total Body Irradiation undergoing Umbilical Cord Blood Transplantation (non-TBI-RI-UCBT) Induces Successful Engraftment in Adult Patients with Advanced Hematological Malignancies.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5177-5177
Author(s):  
Ko Miyamoto ◽  
Shigesaburo Miyakoshi ◽  
Aki Kyo ◽  
Koichiro Yuji ◽  
Eiji Kusumi ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord Blood ◽  
Hematological Malignancies ◽  
Cord Blood Transplantation ◽  
Conditioning Regimen ◽  
Umbilical Cord Blood Transplantation ◽  
Blood Transplantation ◽  
Overt Leukemia ◽  
Neutrophil Engraftment

Abstract Purpose: In a phase I study to evaluate the feasibility and safety of non-TBI-RI-UCBT in patients with advanced hematological malignancies, who were ineligible for conventional allogeneic hematopoietic stem cell transplantation. Patients and Methods: We treated a total of 6 patients (2 Hodgkin disease, 3 Follicular Lymphoma, 1 MDS overt leukemia). There were 4 female and 2 male, with a median age of 52.5 (46–62) years old. At the transplantation, all patients were in progressive disease (high-risk). Two patients with lymphoma had failed one or more preceding autologous transplants and a patient with overt leukemia had failed an allogeneic transplant. Backbone agent in the conditioning regimen was fludarabine, in combination with melphalan (n=4), or melphalan and thiotepa (n=2). Graft-versus-host disease (GVHD) prophylaxis incorporated cyclosporine alone (n=3), or FK506 alone (n=3). All of the patients received 4 of 6 HLA -antigen-matched umbilical cord blood transplantation. The median number of infused total nucleated cell dose and CD34 plus cell dose before freezing were 3.18 x 107 (2.77–4.7) /kg and 0,85 x 105 (0.57–1.91) /kg, respectively. Results: All of the patients achieved primary neutrophil engraftment. The median time to reach 0.5 x 109/L neutrophils was 24 (13–31) days. Platelet counts above 20 x 109/L were achieved by 3 patients on median day of 40 (39–45) days. The median time to complete donor chimerism was 26.5 (16–35) days. Acute GVHD occurred in 2 of the 6 patients (grade I/II in 2). Chronic GVHD developed in none of the evaluable patients. Two of the 6 patients developed noninfectious fever before neutrophil engraftment. Three patients died of TRM (1 pneumonia, 1 thrombotic microangiopathy, 1 acute heart failure), and the other 2 patients died due to disease progression. At a median follow-up of 65.5 days (33–78), one of the 6 patients is currently alive in CR. Conclusion: Although this study is preliminary with a small number of patients and short follow-up, our findings demonstrated the successful engraftment of non-TBI-RI-UCBT for adult patients with relapsed/refractory hematological malignancies. Prospective study to further evaluate the efficacy of non-TBI-RI-UCBT for hematological malignancies is warranted.

Comparison of Outcomes after Double or Single-Unit Cord Blood Transplantation in Patients with Hematological Malignancies Using TBI-Containing Myeloablative Conditioning Regimen, a Retrospective Matched Control Study on Behalf of C-SHOT0507 and JSHCT Registry Data in Japan

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2548-2548
Author(s):  
Atsushi Wake ◽  
Shunro Kai ◽  
Masaya Okada ◽  
Koji Kato ◽  
Naoyuki Uchida ◽  
...  
Keyword(s):  
Cord Blood ◽  
Phase Ii ◽  
Single Unit ◽  
Hematological Malignancies ◽  
Matched Control ◽  
Disease Risk ◽  
Cord Blood Transplantation ◽  
Myeloablative Conditioning ◽  
Blood Transplantation ◽  
Gvhd Prophylaxis

Abstract INTRODUCITON: We reported the outcomes of double-unit cord blood transplantation (dCBT) after myeloablative conditioning performed in a prospective multicenter phase II study (C-SHOT0507) (Biol Blood Marrow Transplant 19, 2013: 812-819). However, the benefit of using double unit compared to single unit was not clearly shown. We performed matched control analysis to compare dCBT and single-unit CBT (sCBT), using C-SHOT0507 data of dCBT and registry data of sCBT. METHODS: Between Apr.2006 and Jan.2010, 61 cases of dCBT in C-SHOT0507 phase II clinical study and 932 cases of sCBT were performed in Japan. Because all cases of dCBT perfomed by TBI12Gy containing myeloablative conditioning (CA/Cy/TBI +/- G-CSF for myeloid and Cy/TBI for lymphoid) and uniform GVHD prophylaxis (CSA/MTX), we excluded reduced intensity conditioning and myeloablative conditioning without TBI 12 Gy from the cases of sCBT. Finally 307 sCBT patients who had hematological malignancies (AML170, ALL80, MDS24, CML14 and ML20) were extracted. All the sCBT recipients received uniform preconditioning described above and same GVHD prophylaxis (CSA/MTX), selected as a matched control cohort of dCBT C-SHOT0507 study. All statistical analyses were performed using EZR (Kanda Y, Saitama Medical Center, Jichi Medical University), a graphical user interface for R (The R Foundation for Statistical Computing, version 2.13.0). RESULTS: Median observation period of survivors was 1431 (106-2315) days post-transplant. Backgrounds of dCBT group and matched-control sCBT group were comparable except gender: (dCBT:M/F = 53 /8 versus sCBT:M/F = 154/153). Median age were 37 (10-54) in dCBT and 40 (14-54) in sCBT. Disease risk included standard 27, advanced 34 cases in dCBT, and standard 142, advanced 165 cases in sCBT. sCBT were grouped according to infused TNC number; 148 cases of low TNC (<2.5x107/kg) group (lowTNC) including 35 cases of <2.0x107/kg, and 159 cases of high TNC (>=2.5x107/kg) group (highTNC). Cumulative incidence (C.I.) of neutrophil engraftment were 87.2% (69.5-95.0) in dCBT, 84.7% (76.2-90.3) in sCBT of low TNC and 86.8% (79.3-91.7) in those of high TNC (n.s.) [Figure] and median days of engraftment were 25, 23, 22 days, respectively. 3yEFS were 44.3% (31.8-56.7), 41.6% (33.5-49.7), 44.0% (36.1-51.9) [Figure], and 3yOS were 52.3% (39.7-64.8), 48.7% (40.5-56.9), 51.0%(43.1-59.0), respectively. There were no statistically significant differences in both of them. C.I. of NRM were 24.1% (13.9-35.7), 31.0% (22.0-40.3), 40.0% (18.0-61.3), acute GVHDII-IV were 30.8% (18.2-44.4), 41.9% (33.1-50.4), 54.8% (45.5-63.1), acute GVHDIII-IV were 10.8% (3.2-23.6), 12.7% (6.8-20.6), 19.0% (11.4-28.1), chronic GVHD were 31.6% (19.8-44.1), 41.4% (32.6-50.0), 33.8% (26.2-41.6), and relapse incidences were 24.6% (14.6-36.1), 24.5% (17.7-31.8), 26.3% (19.6-33.5), respectively. All parameters assessed showed no significant differences between dCBT, sCBT, sCBT of low TNC and high TNC, except C.I of acute GVHDII-IV and NRM. In multivariate analysis, disease risk was an only significant factor affected on EFS (HR0.58; 95%CI: 0.400-0.833, P=0.003). DISCUSSION: Although this is a retrospective analysis, double-unit use for CBT showed no statistically significant impact on engraftment rate and transplant outcomes compared to single-unit use of CBT even in patients of TNC number lower than 2.5x107/kg after myeloablative conditioning in Japan. Since more than 90% of the transplant candidates can find single CB unit >2x107/kg TNC, advantage of adding another CB unit may be quite limited in Japan both scientifically and financially, until meaningful benefit is demonstrated by randomized phase III study such as BMT-CTN 0501. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

Outcomes of Adolescents and Young Adults Compared with Children with Acute Leukemia after Single-Unit Unrelated Cord Blood Transplantation Using Myeloablative Conditioning without Antithymocyte Globulin

2021 ◽  
pp. 1-11
Author(s):  
Xuhan Zhang ◽  
Huilan Liu ◽  
Changcheng Zheng ◽  
Baolin Tang ◽  
Xiaoyu Zhu ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Single Unit ◽  
Antithymocyte Globulin ◽  
Immune Reconstitution ◽  
Cord Blood Transplantation ◽  
Myeloablative Conditioning ◽  
Platelet Recovery ◽  
Blood Transplantation ◽  
Cell Counts ◽  
Neutrophil Engraftment

<b><i>Background:</i></b> Although the use of cord blood transplantation (CBT) is becoming more frequent in acute leukemia, considering the relationship between the low stem cell dose and graft failure, whether use of CBT for adolescents and young adults (AYAs) is appropriate remains uncertain. <b><i>Methods:</i></b> A retrospective registry-based analysis of clinical outcomes and immune reconstitution was conducted for 105 AYAs and 187 children with acute leukemia who underwent single-unit CBT using myeloablative conditioning (MAC) without antithymocyte globulin (ATG). <b><i>Results:</i></b> Outcomes were similar between AYAs and children, except for nonrelapse mortality (NRM) and recovery rates of neutrophils and platelets. The 30-day cumulative incidence of neutrophil engraftment was similar between AYAs and children, but children had faster rates of neutrophil and platelet recovery than AYAs. The median time to neutrophil engraftment was earlier in children than in AYAs (AYAs, 19 days, 95% confidence interval [CI] 17.3–21.7; children, 16 days, 95% CI 13.1–19.5, <i>p =</i> 0.00003). The incidence of platelet recovery on day 120 was higher in children than in AYAs (AYAs, 80%, 95% CI 71–81%; children, 88%, 95% CI 82–92%, <i>p =</i> 0.037). CD34<sup>+</sup> cell dose was the only independent factor influencing both neutrophil and platelet recovery. The cumulative incidence of NRM at 2 years was higher among AYAs than among children (AYAs, 27.5%, 95% CI 20–37%; children, 15%, 95% CI 10–21%, <i>p =</i> 0.008). Conditioning regimen was an independent factor influencing NRM. With respect to immune reconstitution, natural killer cell counts quickly recovered to normal levels 1-month post-CBT in both children and AYAs. CD8<sup>+</sup> T-cell counts were higher in children than in AYAs at 1 and 3 months post-CBT. CD4<sup>+</sup> T-cell counts were similar in both children and AYAs after CBT. <b><i>Conclusion:</i></b> AYAs with acute leukemia have outcomes of single-unit CBT using MAC without ATG that are as good as those of children. Thus, single-unit CBT using modified MAC without ATG is an acceptable choice for both AYAs and children who do not have a suitable donor.

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