Unrelated cord blood transplants in adults with hematologic malignancies.
OBJECTIVE
We analyzed outcomes and risk factors after unrelated cord blood transplantation (CBT) in adults with hematologic malignancies.


METHODS
One hundred and seventy-one patients were transplanted after 1997. Their median age was 29 years (15-55), and the median follow-up time was 18 months (1-71). Most patients had acute or chronic leukemia (n=142, 83%), 91 (53%) were transplanted in advanced phase and an autologous transplant had failed in 32 (19%). Most patients (87%) received an HLA-mismatched cord blood unit with 1-2 HLA disparities. At infusion, the median number of nucleated cells and CD34(+) cells was 2.1x10(7)/kg and 1x10(5)/kg, respectively


RESULTS
The cumulative incidence of neutrophil recovery at day 60 was 72+/-3% with a median of 28 days (11-57). A higher neutrophil count and use of hematopoietic growth factors were independently associated with faster neutrophil recovery. The cumulative incidence of grade II-IV acute graft-versus-host disease was 32+/-4% and this complication was not associated with the number of HLA mismatches. The 2-year cumulative incidence of chronic graft-versus-host disease, transplant related-mortality and relapse were 36+/-10%, 51+/-4% and 22+/-4%, respectively. At 2-years, disease-free-survival for patients transplanted in early, intermediate and advanced phases of disease was 41+/-9%, 34+/-10% and 18+/-4%, respectively. In multivariate analyses, advanced disease status was an adverse factor for relapse and disease-free survival.


CONCLUSIONS
Unrelated CBT is a clear alternative for adults with hematological malignancies lacking an HLA-matched related or unrelated donor. The choice of units containing a higher neutrophil count and a policy of earlier transplantation are likely to provide better results.
Arcese
William
W
Eurocord-Netcord.
Rocha
Vanderson
V
Labopin
Myriam
M
Sanz
Guillermo
G
Iori
Anna Paola
AP
de Lima
Marcos
M
Sirvent
Anne
A
Busca
Alessandro
A
Asano
Shigheta
S
Ionescu
Irina
I
Wernet
Peter
P
Gluckman
Eliane
E
D000293:Adolescent; D000328:Adult; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D009504:Neutrophils; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome