Abstract
This retrospective study considered the outcomes of 181 patients with acute myeloid leukemia ( AML ) transplanted in second complete remission ( CR 2) between January 2005 and April 2012 and who received either a myeloablative autologous stem cell transplant (Auto‐ SCT ; n = 82; median age: 48 years; median follow‐up: 45 months) or an umbilical cord blood ( UCB ) allogeneic SCT ( n = 99, median age: 46 years; median follow‐up: 36 months; conditioning regimens: myeloablative n = 21, reduced n = 78; single unit n = 37, double units n = 62). Although the Auto group showed a significant better prognostic profile at transplant, with longer median interval between diagnosis and time of graft, higher incidence of good‐risk cytogenetics and lower number of previously transplanted patients, 3‐year OS and LFS were similar between both groups (Auto: 59 ± 6% vs. 50 ± 6%, P = 0.45; and 57 ± 6% vs. 46 ± 6%, P = 0.37). In multivariate analysis, UCB allo‐ SCT was associated with lower relapse incidence ( HR : 0.3, 95% CI : 0.11–0.82, P = 0.02), but higher non‐relapse mortality ( NRM ) ( HR : 4.16; 95% CI : 1.46–11.9, P = 0.008). Results from this large study suggest that UCB allo‐ SCT provides better disease control than auto‐ SCT , which is especially important in the setting of high‐risk disease. However, this disease control advantage is counterbalanced by higher toxicity, highlighting the need for novel approaches aiming to decrease NRM after UCB allo‐ SCT .