title: Comparative single-institute analysis of cord blood transplantation from unrelated donors with bone marrow or peripheral blood stem-cell transplants from related donors in adult patients with hematologic malignancies after myeloablative conditioning regimen.
abstract: We studied the clinical outcomes of 171 adults with hematologic malignancies who received unrelated cord blood transplantation (CBT) as a primary unrelated stem-cell source (n=100), or bone marrow transplant (BMT) or peripheral blood stem-cell transplant (PBSCT) from related donors (n=71, 55 BMT and 16 PBSCT). All patients received myeloablative regimens including 12 Gy total body irradiation. We analyzed the hematologic recovery, and risks of graft-versus-host disease (GVHD), transplantation-related mortality (TRM) and relapse, and disease-free survival (DFS) using Cox proportional hazards models. Significant delays in engraftment occurred after cord blood transplantation; however, overall engraftment rates were almost the same for both grafts. The cumulative incidences of grades III to IV acute and extensive-type chronic GVHDs among CBT recipients were significantly lower than those among BMT/PBSCT recipients. Multivariate analysis demonstrated no apparent differences in TRM (9% in CBT and 13% in BMT/PBSCT recipients), relapse (17% in CBT and 26% in BMT/PBSCT recipients), and DFS (70% in CBT and 60% in BMT/PBSCT recipients) between both groups. These data suggest that unrelated cord blood could be as safe and effective a stem-cell source as related bone marrow or mobilized peripheral blood for adult patients when it is used as a primary unrelated stem-cell source.
authors.affiliation: Division of Molecular Therapy, Institute of Medical Science, Department of Biostatistics/Epidemiology and Preventive Health Sciences, School of Health Sciences and Nursing, University of Tokyo, Japan. radius@ims.u-tokyo.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Jun
authors.initials: J
authors.lastname: Ooi
authors.forename: Akira
authors.initials: A
authors.lastname: Tomonari
authors.forename: Takaaki
authors.initials: T
authors.lastname: Konuma
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tsukada
authors.forename: Maki
authors.initials: M
authors.lastname: Oiwa-Monna
authors.forename: Kenji
authors.initials: K
authors.lastname: Fukuno
authors.forename: Michihiro
authors.initials: M
authors.lastname: Uchiyama
authors.forename: Kashiya
authors.initials: K
authors.lastname: Takasugi
authors.forename: Tohru
authors.initials: T
authors.lastname: Iseki
authors.forename: Arinobu
authors.initials: A
authors.lastname: Tojo
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Asano
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000401:mortality; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006086:Graft vs Host Disease; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods*; D014916:Whole-Body Irradiation