The impact of measurable residual disease (MRD) on cord blood transplantation (CBT) outcomes has remained debated. To address this issue, we assessed the impact of measurable MRD at CBT on outcomes in large cohort of patients with acute leukemia. Inclusion criteria included adult patients with acute myeloid (AML) or acute lymphoblastic leukemia (ALL), CBT as first allo‐HCT in first or second complete remission (CR) at transplantation, and known MRD status at the time of CBT. Data from 506 patients were included in the analysis. Among them, 317 patients had AML and 189 had ALL. Positive MRD was reported in 169 (33%) patients while the remaining 337 patients were MRD negative at CBT. At 2 years, relapse incidence was 18% in patients with MRD negativity vs 33% in those with MRD positivity at transplantation (P < .001). Two‐year leukemia‐free survival (LFS) and overall survival (OS) were 57% and 60%, respectively, in MRD negative patients, vs 38% (P < .001) and 48% (P = .004), respectively, in those with MRD positivity. There was no interaction between the impact of MRD on OS and LFS and diagnosis (ie, ALL vs AML), single or double CBT, and reduced‐intensity or myeloablative conditioning. On multivariate analysis, MRD positivity was associated with a higher risk of relapse (HR = 1.8, P = .003), comparable non‐relapse mortality (P = .44), worse LFS (HR = 1.4, P = .008) and a trend towards worse OS (HR = 1.3, P = .065). In conclusion, these data suggest that novel strategies that are aiming to achieve MRD negativity at CBT are needed for leukemic patients with positive MRD pre‐CBT.

中文翻译：

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可检测的残留病对脐带血移植的影响。

可测量的残留疾病（MRD）对脐血移植（CBT）结果的影响仍存在争议。为了解决这个问题，我们评估了CBT时可测量的MRD对大量急性白血病患者结局的影响。入选标准包括成年急性髓细胞性白血病（AML）或急性淋巴细胞性白血病（ALL），在首次或第二次完全缓解（CR）中以CBT作为第一同种异体HCT的成年患者，以及在CBT时已知的MRD状态。分析中包括了506位患者的数据。其中，317例患有AML，189例患有ALL。169例（33％）患者报告MRD阳性，而其余337例CBT患者MRD阴性。2年时，MRD阴性患者的复发发生率为18％，而移植时MRD阳性的患者为33％（P<.001）。MRD阴性患者的两年无白血病生存率（LFS）和总生存率（OS）分别为57％和60％，而38％（P <.001）和48％（P = .004） ，具有MRD阳性的患者。MRD对OS和LFS的影响与诊断（即ALL与AML），单CBT或双CBT以及降低强度或清髓条件之间没有相互作用。在多变量分析中，MRD阳性与复发风险较高（HR = 1.8，P = .003），可比的非复发死亡率（P = .44），较差的LFS（HR = 1.4，P = .008）和OS恶化的趋势（HR = 1.3，P= .065）。总之，这些数据表明，MRD前CBT阳性的白血病患者需要新颖的策略，旨在在CBT上实现MRD阴性。