Outcomes after transplantation of cord blood or bone marrow from unrelated donors in adults with leukemia.
BACKGROUND
Data regarding the outcome of cord-blood transplantation in adults are scant, despite the fact that these grafts are increasingly used in adults.


METHODS
We compared the outcomes of the transplantation of hematopoietic stem cells from unrelated donors in adults with leukemia who had received cord blood that was mismatched for one HLA antigen (34 patients) or two antigens (116 patients), bone marrow that had one HLA mismatch (83 patients), and HLA-matched bone marrow (367 patients). We used Cox proportional-hazards models to analyze the data.


RESULTS
Cord-blood recipients were younger and more likely to have advanced leukemia than were bone marrow recipients, and they received lower doses of nucleated cells. Hematopoietic recovery was slower with transplantation of mismatched bone marrow and cord blood than with matched marrow transplantations. Acute graft-versus-host disease (GVHD) was more likely to occur after mismatched marrow transplantation, and chronic GVHD was more likely to occur after cord-blood transplantation. The rates of treatment-related mortality, treatment failure, and overall mortality were lowest among patients who received matched marrow transplants. Patients who received mismatched bone marrow transplants and those who received mismatched cord-blood transplants had similar rates of treatment-related mortality (P=0.96), treatment failure (P=0.69), and overall mortality (P=0.62). There were no differences in the rate of recurrence of leukemia among the groups. There were no differences in outcome after cord-blood transplantation between patients with one HLA mismatch and those with two HLA mismatches.


CONCLUSIONS
HLA-mismatched cord blood should be considered an acceptable source of hematopoietic stem-cell grafts for adults in the absence of an HLA-matched adult donor.
Laughlin
Mary J
MJ
Case Comprehensive Cancer Center and University Hospitals of Cleveland Ireland Cancer Center, Cleveland, USA.
Eapen
Mary
M
Rubinstein
Pablo
P
Wagner
John E
JE
Zhang
Mei-Jei
MJ
Champlin
Richard E
RE
Stevens
Cladd
C
Barker
Juliet N
JN
Gale
Robert P
RP
Lazarus
Hillard M
HM
Marks
David I
DI
van Rood
Jon J
JJ
Scaradavou
Andromachi
A
Horowitz
Mary M
MM
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001792:Blood Platelets / Q000502:physiology; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000276:immunology / Q000401:mortality; D002908:Chronic Disease; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D005312:Fetal Blood / Q000276:immunology / Q000637:transplantation; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D006650:Histocompatibility Testing; D006801:Humans; D007938:Leukemia / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000628:therapy; D009504:Neutrophils / Q000502:physiology; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors; D016896:Treatment Outcome