title: Reduced late mortality risk contributes to similar survival after double-unit cord blood transplantation compared with related and unrelated donor hematopoietic stem cell transplantation.
abstract: Cord blood transplantation (CB-T) is increasingly used as a treatment alternative for hematologic malignancies. However, how CB-T compares to related (RD-T) and unrelated donor transplantation (URD-T) is not established. We compared survival of 75 double-unit CB-T, 108 RD-T, and 184 URD-T recipients who received transplants over the same period for the treatment of hematologic malignancies. Patients had similar ages and disease risk, and a similar percentage had acute leukemia. The incidence of day 180 transplant-related mortality (TRM) of 21% (95% confidence interval [CI]: 12-31) after CB-T was higher than that of RD-T recipients. However, this was compensated for by a low risk of TRM after day 180, and a relatively low incidence of relapse. Hence, the 2-year progression-free survival (PFS) of 55% (95% CI: 45-68) after CB-T was similar to that after RD-T or URD-T (P = .573). In multivariate analysis, donor source had no influence on PFS, with the only significant factors being recipient age and disease risk. In a subanalysis of 201 patients with acute leukemia, CB-T, RD-T, and URD-T recipients also had similar 2-year disease-free survival (P = .482). These data provide strong support for the further investigation of double-unit CB grafts as an alternative hematopoietic stem cell source.
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
authors.forename: Doris M
authors.initials: DM
authors.lastname: Ponce
authors.forename: Junting
authors.initials: J
authors.lastname: Zheng
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Gonzales
authors.forename: Marissa
authors.initials: M
authors.lastname: Lubin
authors.forename: Glenn
authors.initials: G
authors.lastname: Heller
authors.forename: Hugo
authors.initials: H
authors.lastname: Castro-Malaspina
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.forename: Katharine
authors.initials: K
authors.lastname: Hsu
authors.forename: Ann A
authors.initials: AA
authors.lastname: Jakubowski
authors.forename: Robert R
authors.initials: RR
authors.lastname: Jenq
authors.forename: Guenther
authors.initials: G
authors.lastname: Koehne
authors.forename: Esperanza B
authors.initials: EB
authors.lastname: Papadopoulos
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Perales
authors.forename: Marcel R
authors.initials: MR
authors.lastname: van den Brink
authors.forename: James W
authors.initials: JW
authors.lastname: Young
authors.forename: Farid
authors.initials: F
authors.lastname: Boulad
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Kernan
authors.forename: Rachel
authors.initials: R
authors.lastname: Kobos
authors.forename: Susan
authors.initials: S
authors.lastname: Prockop
authors.forename: Andromachi
authors.initials: A
authors.lastname: Scaradavou
authors.forename: Trudy
authors.initials: T
authors.lastname: Small
authors.forename: Richard J
authors.initials: RJ
authors.lastname: O'Reilly
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Barker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors; D055815:Young Adult