Disease-specific analyses of unrelated cord blood transplantation compared with unrelated bone marrow transplantation in adult patients with acute leukemia.
We made a disease-specific comparison of unrelated cord blood (CB) recipients and human leukocyte antigen allele-matched unrelated bone marrow (BM) recipients among 484 patients with acute myeloid leukemia (AML; 173 CB and 311 BM) and 336 patients with acute lymphoblastic leukemia (ALL; 114 CB and 222 BM) who received myeloablative transplantations. In multivariate analyses, among AML cases, lower overall survival (hazard ratio [HR]=1.5; 95% confidence interval [CI], 1.0-2.0, P= .028) and leukemia-free survival (HR=1.5; 95% CI, 1.1-2.0, P= .012) were observed in CB recipients. The relapse rate did not differ between the 2 groups of AML (HR=1.2; 95% CI, 0.8-1.9, P= .38); however, the treatment-related mortality rate showed higher trend in CB recipients (HR=1.5; 95% CI, 1.0-2.3, P= .085). In ALL, there was no significant difference between the groups for relapse (HR=1.4, 95% CI, 0.8-2.4, P= .19) and treatment-related mortality (HR=1.0; 95% CI, 0.6-1.7, P= .98), which contributed to similar overall survival (HR=1.1; 95% CI, 0.7-1.6, P= .78) and leukemia-free survival (HR=1.2; 95% CI, 0.9-1.8, P= .28). Matched or mismatched single-unit CB is a favorable alternative stem cell source for patients without a human leukocyte antigen-matched related or unrelated donor. For patients with AML, decreasing mortality, especially in the early phase of transplantation, is required to improve the outcome for CB recipients.
Atsuta
Yoshiko
Y
Department of Hematopoietic Stem Cell Transplantation Data Management, Nagoya University School of Medicine, Higashi-ku Nagoya, Japan. y-atsuta@med.nagoya-u.ac.jp
Suzuki
Ritsuro
R
Nagamura-Inoue
Tokiko
T
Taniguchi
Shuichi
S
Takahashi
Satoshi
S
Kai
Shunro
S
Sakamaki
Hisashi
H
Kouzai
Yasushi
Y
Kasai
Masaharu
M
Fukuda
Takahiro
T
Azuma
Hiroshi
H
Takanashi
Minoko
M
Okamoto
Shinichiro
S
Tsuchida
Masahiro
M
Kawa
Keisei
K
Morishima
Yasuo
Y
Kodera
Yoshihisa
Y
Kato
Shunichi
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D001792:Blood Platelets / Q000166:cytology; D016026:Bone Marrow Transplantation / Q000401:mortality*; D002423:Cause of Death; D036101:Cord Blood Stem Cell Transplantation / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000453:epidemiology; D006650:Histocompatibility Testing; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009504:Neutrophils / Q000166:cytology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality* / Q000628:therapy*; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult