Comparison of unrelated cord blood transplantation and HLA-mismatched unrelated bone marrow transplantation for adults with leukemia.
Recent advances in unrelated cord blood transplantation (UCBT) and high-resolution typing of human leukocyte antigen (HLA) from an unrelated donor have increased choices in alternative donor/stem cell source selection. We assessed HLA-mismatched locus-specific comparison of the outcomes of 351 single-unit UCB and 1,028 unrelated bone marrow (UBM) adult recipients 16 years old or older at the time of transplantation who received first stem cell transplantation with myeloablative conditioning for acute leukemia or myelodysplastic syndromes. With adjusted analyses, HLA 0 to 2 mismatched UCBT showed similar overall mortality (relative risk [RR] = 0.85, 95% confidence interval [CI], 0.68-1.06; P = .149) compared with that of single-HLA-DRB1-mismatched UBMT. UCBT showed inferior neutrophil recovery (RR = 0.50, 95% CI, 0.42-0.60; P < .001), lower risk of acute graft-versus-host disease (RR = 0.55, 95% CI, 0.42-0.72; P < .001), and lower risk of transplantation-related mortality (RR = 0.68, 95% CI, 0.50-0.92; P = .011) compared with single-HLA-DRB1-mismatched UBMT. No significant difference was observed for risk of relapse (RR = 1.28, 95% CI, 0.93-1.76; P = .125). HLA 0 to 2 antigen-mismatched UCBT is a reasonable second alternative donor/stem cell source with a survival outcome similar to that of single-HLA-DRB1-mismatched or other 7 of 8 UBMT.
Department of HSCT Data Management/Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan. y-atsuta@med.nagoya-u.ac.jp
Yoshiko
Y
Atsuta
Yasuo
Y
Morishima
Ritsuro
R
Suzuki
Tokiko
T
Nagamura-Inoue
Shuichi
S
Taniguchi
Satoshi
S
Takahashi
Shunro
S
Kai
Hisashi
H
Sakamaki
Yasushi
Y
Kouzai
Naoki
N
Kobayashi
Takahiro
T
Fukuda
Hiroshi
H
Azuma
Minoko
M
Takanashi
Takehiko
T
Mori
Masahiro
M
Tsuchida
Takakazu
T
Kawase
Keisei
K
Kawa
Yoshihisa
Y
Kodera
Shunichi
S
Kato
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D036101:Cord Blood Stem Cell Transplantation; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007938:Leukemia / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012307:Risk Factors; D019172:Transplantation Conditioning; D061349:Unrelated Donors
D000970:Antineoplastic Agents; D006680:HLA Antigens