TY - JOUR
T1 - A decision analysis comparing unrelated bone marrow transplantation and cord blood transplantation in patients with aggressive adult T-cell leukemia-lymphoma
AU - Fuji, Shigeo
AU - Kurosawa, Saiko
AU - Inamoto, Yoshihiro
AU - Murata, Tatsunori
AU - Utsunomiya, Atae
AU - Uchimaru, Kaoru
AU - Yamasaki, Satoshi
AU - Inoue, Yoshitaka
AU - Moriuchi, Yukiyoshi
AU - Choi, Ilseung
AU - Ogata, Masao
AU - Hidaka, Michihiro
AU - Yamaguchi, Takuhiro
AU - Fukuda, Takahiro
N1 - Publisher Copyright:
© 2019, Japanese Society of Hematology.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - 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.
AB - 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.
KW - ATL
KW - Adult T-cell leukemia-lymphoma
KW - Decision analysis
KW - Prognostic index
KW - Transplantation
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U2 - 10.1007/s12185-019-02777-w
DO - 10.1007/s12185-019-02777-w
M3 - Article
C2 - 31701480
AN - SCOPUS:85074914476
SN - 0925-5710
VL - 111
SP - 427
EP - 433
JO - International Journal of Hematology
JF - International Journal of Hematology
IS - 3
ER -