title: Unrelated cord blood transplants in adults with hematologic malignancies.
abstract: 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.
authors.affiliation: Eurocord-Netcord.
authors.forename: William
authors.initials: W
authors.lastname: Arcese
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.forename: Guillermo
authors.initials: G
authors.lastname: Sanz
authors.forename: Anna Paola
authors.initials: AP
authors.lastname: Iori
authors.forename: Marcos
authors.initials: M
authors.lastname: de Lima
authors.forename: Anne
authors.initials: A
authors.lastname: Sirvent
authors.forename: Alessandro
authors.initials: A
authors.lastname: Busca
authors.forename: Shigheta
authors.initials: S
authors.lastname: Asano
authors.forename: Irina
authors.initials: I
authors.lastname: Ionescu
authors.forename: Peter
authors.initials: P
authors.lastname: Wernet
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
mesh_terms: 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