A decision analysis comparing unrelated bone marrow transplantation and cord blood transplantation in patients with aggressive adult T-cell leukemia-lymphoma

Shigeo Fuji, Saiko Kurosawa, Yoshihiro Inamoto, Tatsunori Murata, Atae Utsunomiya, Kaoru Uchimaru, Satoshi Yamasaki, Yoshitaka Inoue, Yukiyoshi Moriuchi, Ilseung Choi, Masao Ogata, Michihiro Hidaka, Takuhiro Yamaguchi, Takahiro Fukuda

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Abstract

Patients with aggressive adult T-cell leukemia-lymphoma (ATL) have dismal outcomes with intensive chemotherapy. Early up-front allogeneic hematopoietic stem cell transplantation (allo-HSCT) is generally recommended. However, the choice of stem cell source, i.e., unrelated bone marrow transplant (UBMT) or cord blood transplantation (CBT), when an HLA-matched related donor is unavailable remains controversial. Thus, we undertook a decision analysis to compare the outcomes of two therapeutic strategies: chemotherapy followed by up-front UBMT at 6 months, and chemotherapy followed by up-front CBT at 3 months. Patients were stratified into low-, intermediate-, and high-risk groups according to the modified ATL-prognostic index. The model simulated life expectancy (LE) and quality-adjusted LE (QALE). LE following up-front UBMT was higher than that following up-front CBT in the low-risk group (2.63 vs. 2.28 years), but was comparable in the intermediate- (2.06 vs. 2.01 years) and high-risk groups (1.25 vs. 1.30 years). The Monte Carlo simulation for LE and QALE in each risk group showed that there was significant uncertainty in all categories. In conclusion, up-front UBMT was superior to up-front CBT in the low-risk group, but the strategies were comparable in the intermediate- and high-risk groups.

Original languageEnglish
Pages (from-to)427-433
Number of pages7
JournalInternational journal of hematology
Volume111
Issue number3
DOIs
Publication statusPublished - 2020 Mar 1

Keywords

  • ATL
  • Adult T-cell leukemia-lymphoma
  • Decision analysis
  • Prognostic index
  • Transplantation

ASJC Scopus subject areas

  • Hematology

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    Fuji, S., Kurosawa, S., Inamoto, Y., Murata, T., Utsunomiya, A., Uchimaru, K., Yamasaki, S., Inoue, Y., Moriuchi, Y., Choi, I., Ogata, M., Hidaka, M., Yamaguchi, T., & Fukuda, T. (2020). A decision analysis comparing unrelated bone marrow transplantation and cord blood transplantation in patients with aggressive adult T-cell leukemia-lymphoma. International journal of hematology, 111(3), 427-433. https://doi.org/10.1007/s12185-019-02777-w