Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies

Abstract

Unrelated cord blood transplantation (CBT) has now become more common, but as yet there have been only a few reports on its outcome compared with bone marrow transplantation (BMT), especially for adults. We studied the clinical outcomes of 113 adult patients with hematologic malignancies who received unrelated BM transplants (n ‫؍‬ 45) or unrelated CB transplants (n ‫؍‬ 68). We analyzed the hematopoietic recovery, rates of graftversus-host disease (GVHD), risks of transplantation-related mortality (TRM) and relapse, and disease-free survival (DFS) using Cox proportional hazards models. The time from donor search to transplantation was significantly shorter among CB transplant recipients (median, 2 months) than BM transplant recipients (median, 11 months; P < .01). Multivariate analysis demonstrated slow neutrophil (P < .01) and platelet (P < .01) recoveries in CBT patients compared with BMT patients. Despite rapid tapering of immunosuppressants after transplantation and infrequent use of steroids to treat severe acute GVHD, there were no GVHD-related deaths among CB transplant recipients compared with 10 deaths of 24 among BM transplant recipients. Unrelated CBT showed better TRM and DFS results compared with BMT (P ‫؍‬ .02 and P < .01, respectively), despite the higher human leukocyte antigen mismatching rate and lower number of infused cells. These data strongly suggest that CBT could be safely and effectively used for adult patients with hematologic malignancies. (Blood. 2004;104:3813-3820)

Impact of the source of hematopoietic stem cell in unrelated transplants: Comparison between 10/10, 9/10‐HLAmatched donors and cord blood

“…These results are consistent with previous reports [2,3,6,14,26,27]. The absence of significant increased incidence of acute and cGVHD after 9/10-HLA MMUD in comparison with 10/10-HLA MUD (data not shown) may be explained by a larger use of pre-transplant ATG in the MMUD group and of peripheral blood as a stem cell source in the MUD group.…”

“…However, we recently published a study conducted in acute myeloid leukemia patients over 50 which shows similar NRM and survival rates after unrelated donor and UCB transplants [28]. With high resolution HLA typing including HLA-DQB1 locus (10 digits), our results reinforce previously published results [2,3,6,[11][12][13][14]16,26,27,29], suggesting that UCB is an equally suitable stem cell source as MMUD, even if larger samples would have allowed for more powerful conclusions.…”

“…The absence of significant increased incidence of acute and cGVHD after 9/10-HLA MMUD in comparison with 10/10-HLA MUD (data not shown) may be explained by a larger use of pre-transplant ATG in the MMUD group and of peripheral blood as a stem cell source in the MUD group. Also, engraftment failure in UCB, was found to be slightly higher (16%) than what is usually observed [2,3,12,27]. It could be related to the fact that 30 (47%) of the UCB patients received less than the target dose of 3 3 10 7 total nuclear cells/kg of recipient, which might have resulted in lower polynuclear neurophils (PN) recovery.…”

“…This report is one of the few to compare transplant outcomes from full 10/10-HLA matched, 9/10-HLA mismatched unrelated donors, and 4-6/6-HLA UCB units. (27) (15,25) 47 (24) 22 (26) 24 (38) (25,35) 32 (16) 21 (25) 11 (17) (35,45) 56 (29) 21 (25) Regimens not meeting these criteria were considered to be reduced intensity conditioning regimens (RIC).…”

Cord blood transplants supported by co-infusion of mobilized hematopoietic stem cells from a third-party donor

“…[8][9][10] In addition, several registry and single institution studies have shown, both for children and adults, overall and disease-free survival rates similar to other allogeneic HSC transplants, although with different causes of mortality. [11][12][13][14][15][16][17][18] Slow and low rate of engraftment, infections during lengthy post-transplant neutropenia and toxicity of preparative regimens were recognized as factors for early TRM of CBT in large registry-based observational studies. [13][14] Low cell content in the transplanted product and higher degree of HLA incompatibility are, in turn, the main factors for graft failure and late engraftment.…”