Outcome of initial cord blood transplantation with FM80TBI as conditioning regimen for acute myeloid leukemia

Outcomes of allogeneic stem cell transplantation in older patients with acute myeloid leukemia (AML) have been unsatisfactory. At our center, cord blood transplantation (CBT) using FM80TBI has been implemented in older patients or those with comorbidities. We conducted a retrospective single-center study to evaluate transplantation outcomes in patients with AML who underwent CBT following FM80TBI. The FM80TBI regimen consisted of fludarabine (125 or 150 mg/m²), melphalan (80 mg/m²), and total-body irradiation (4 Gy). This study included 58 patients. The median follow-up period was 38 months. The median age at transplant was 67 (52–73) years. At the time of CBT, 39.7% of all patients having an Eastern Cooperative Oncology Group performance status of ≤ 2 did not achieve complete remission (CR), 25.9% had adverse cytogenetic risk, and 53.4% were positive for Wilms tumor gene-1 messenger RNA in peripheral blood. Neutrophil engraftment by day 42 was achieved in 87.9% of patients. The 3-year overall survival (OS) was 67.1%, the 3-year non-relapse mortality was 14.4%, and the 3-year cumulative incidence of relapse was 20.0%. Patients with CR status at the time of CBT had significantly better 3-year OS than those with non-CR status (86.8% vs. 42.4%, P < 0.05). The cumulative incidences of Grade II–IV acute graft-versus-host disease (GVHD) at day 100 and chronic GVHD at 2 years were 29.4% and 15.0%, respectively. Although this was a single-center retrospective study, the outcomes of CBT for older patients with AML or those with comorbidities following FM80TBI were favorable.