A decision analysis comparing unrelated bone marrow transplantation and cord blood transplantation in patients with aggressive adult T-cell leukemia-lymphoma
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.
KeywordsAdult T-cell leukemia-lymphoma ATL Transplantation Prognostic index Decision analysis
This research was partially supported by the Practical Research for Innovative Cancer Control program of the Japan Agency for Medical Research and Development (19ck0106342h0003) and a National Cancer Research and Development Fund (29-A-14).
SF, SK, YI, TM, TY, and TF participated in research design, data analysis, and manuscript writing. AU, KU, SY, YI, YM, IC, MO, and MH gathered the data. All authors approved of the submission of this manuscript.
Compliance with ethical standards
Conflict of interest
S.F. received honoraria from Kyowa Hakko Kirin Co., Ltd.; T.M. is an employee of Crecon Medical Assessment Inc, Tokyo, Japan; A.U. received honoraria from Japan Blood Products Organization, Roche Diagnostics, Daiichi Sankyo, Siemens, Bristol-Myers Squibb, Pfizer, Astellas Pharma, Kyowa Hakko Kirin, Novartis Pharma, HUYA Bioscience International, Nippon Shinyaku, Chugai Pharma and Celgene, Immuno-Biological Laboratories and Sumitomo Dainippon Pharma; T.Y. had ownership interests in Statcom Co., Ltd., received consulting fees from Ono Pharmaceutical Co., Ltd., received honoraria from Taiho Pharmaceutical Co., Ltd., and received research funding from Kyowa Hakko Kirin Co., Ltd.; M.H. received research funding from Chugai Pharm Co., Ltd.
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