Allogeneic hematopoietic cell transplantation for hematologic malignancy: relative risks and benefits of double umbilical cord blood.
Effectiveness of double umbilical cord blood (dUCB) grafts relative to conventional marrow and mobilized peripheral blood from related and unrelated donors has yet to be established. We studied 536 patients at the Fred Hutchinson Cancer Research Center and University of Minnesota with malignant disease who underwent transplantation with an human leukocyte antigen (HLA)-matched related donor (MRD, n = 204), HLA allele-matched unrelated donor (MUD, n = 152) or 1-antigen-mismatched unrelated adult donor (MMUD, n = 52) or 4-6/6 HLA matched dUCB (n = 128) graft after myeloablative conditioning. Leukemia-free survival at 5 years was similar for each donor type (dUCB 51% [95% confidence interval (CI), 41%-59%]; MRD 33% [95% CI, 26%-41%]; MUD 48% [40%-56%]; MMUD 38% [95% CI, 25%-51%]). The risk of relapse was lower in recipients of dUCB (15%, 95% CI, 9%-22%) compared with MRD (43%, 95% CI, 35%-52%), MUD (37%, 95% CI, 29%-46%) and MMUD (35%, 95% CI, 21%-48%), yet nonrelapse mortality was higher for dUCB (34%, 95% CI, 25%-42%), MRD (24% (95% CI, 17%-39%), and MUD (14%, 95% CI, 9%-20%). We conclude that leukemia-free survival after dUCB transplantation is comparable with that observed after MRD and MUD transplantation. For patients without an available HLA matched donor, the use of 2 partially HLA-matched UCB units is a suitable alternative.
Brunstein
Claudio G
CG
University of Minnesota Medical Center, Minneapolis, MN, USA. runs072@umn.edu
Gutman
Jonathan A
JA
Weisdorf
Daniel J
DJ
Woolfrey
Ann E
AE
Defor
Todd E
TE
Gooley
Theodore A
TA
Verneris
Michael R
MR
Appelbaum
Frederick R
FR
Wagner
John E
JE
Delaney
Colleen
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000097:blood; D006680:HLA Antigens / Q000276:immunology; D019337:Hematologic Neoplasms / Q000517:prevention & control / Q000601:surgery*; D006410:Hematopoiesis; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007938:Leukemia / Q000517:prevention & control / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014184:Transplantation, Homologous; D014470:Umbilical Cord / Q000166:cytology*; D055815:Young Adult
D006680:HLA Antigens