Graft-versus-host disease in children who have received a cord-blood or bone marrow transplant from an HLA-identical sibling. Eurocord and International Bone Marrow Transplant Registry Working Committee on Alternative Donor and Stem Cell Sources.
BACKGROUND
Umbilical-cord blood as an alternative to bone marrow for hematopoietic stem-cell transplantation may lower the risk of graft-versus-host disease (GVHD).


METHODS
We studied the records of 113 recipients of cord blood from HLA-identical siblings from the period from 1990 through 1997 and compared them with the records of 2052 recipients of bone marrow from HLA-identical siblings during the same period. The study population consisted of children 15 years of age or younger. We compared the rates of GVHD, hematopoietic recovery, and survival using Cox proportional-hazards regression to adjust for potentially confounding factors.


RESULTS
Recipients of cord blood were younger than recipients of bone marrow (median age, 5 years vs. 8 years; P<0.001), weighed less (median weight, 17 kg vs. 26 kg; P<0.001), and were less likely to have received methotrexate for prophylaxis against GVHD (28 percent vs. 65 percent, P<0.001). Multivariate analysis demonstrated a lower risk of acute GVHD (relative risk, 0.41; P=0.001) and chronic GVHD (relative risk, 0.35; P=0.02) among recipients of cord-blood transplants. As compared with recovery after bone marrow transplantation, the likelihood of recovery of the neutrophil count and the platelet count was significantly lower in the first month after cord-blood transplantation (relative risk, 0.40 [P<0.001], and relative risk, 0.20 [P<0.001]), respectively. Mortality was similar in the two groups (relative risk of death in the recipients of cord blood, 1.15; P=0.43).


CONCLUSIONS
Recipients of cord-blood transplants from HLA-identical siblings have a lower incidence of acute and chronic GVHD than recipients of bone marrow transplants from HLA-identical siblings.
Rocha
V
V
Eurocord-Cord Blood Transplant Group, Hôpital Saint Louis and University of Paris.
Wagner
J E
JE
Sobocinski
K A
KA
Klein
J P
JP
Zhang
M J
MJ
Horowitz
M M
MM
Gluckman
E
E
D000208:Acute Disease; D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000276:immunology; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D005312:Fetal Blood / Q000276:immunology; D006086:Graft vs Host Disease / Q000209:etiology* / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D009679:Nuclear Family; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis