title: Comparison of transplant outcomes from matched sibling bone marrow or peripheral blood stem cell and unrelated cord blood in patients 50 years or older.
abstract: Older recipient and donor age were associated with higher incidences of severe graft-versus-host disease (GVHD) and mortality after allogeneic hematopoietic stem cell transplantation from matched sibling donors (MSDs) and matched unrelated donors. Since a lower incidence of severe GVHD is advantageous in unrelated cord blood transplantation (CBT), a higher incidence of GVHD using older MSDs could be overcome using cord blood for older patients. We retrospectively analyzed Japanese registration data of 2,091 patients with acute myeloid leukemia, acute lymphoblastic leukemia (ALL), and myelodysplastic syndrome aged 50 years or older who underwent MSD bone marrow transplantation (BMT) (n = 319), MSD peripheral blood stem cell transplantation (PBSCT) (n = 462), or unrelated CBT (n = 1,310) between 2007 and 2012. Median age of MSD was 56 (range, 38-74) years. Compared with CBT, the risk of developing extensive chronic GVHD was higher after BMT (hazard ratio [HR], 2.00; P = 0.001) or PBSCT (HR, 2.38; P < 0.001), and transplant-related mortality was lower after BMT (HR, 0.61; P < 0.001) or PBSCT (HR, 0.63; P < 0.001). Relapse rates were not significant difference between three groups. Although overall mortality was lower after BMT (HR, 0.67; P < 0.001) or PBSCT (HR, 0.75; P = 0.002) compared with CBT, the rates of a composite endpoint of GVHD-free, relapse-free survival (GRFS) were not significant difference between three groups. These data showed that MSDs remain the best donor source for older patients, but CBT led to similar GRFS to BMT and PBSCT.
authors.affiliation: Department of Hematology/Oncology, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Konuma
authors.affiliation: Division of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tsukada
authors.affiliation: Division of Hematology, Jichi Medical University, Saitama Medical Center, Saitama, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Kanda
authors.affiliation: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Uchida
authors.affiliation: Department of Internal Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Japan.
authors.forename: Yuju
authors.initials: Y
authors.lastname: Ohno
authors.affiliation: Department of Hematology, Tokyo Metropolitan Geriatric Hospital, Tokyo.
authors.forename: Shigesaburo
authors.initials: S
authors.lastname: Miyakoshi
authors.affiliation: Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: Heiwa
authors.initials: H
authors.lastname: Kanamori
authors.affiliation: Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hidaka
authors.affiliation: Saiseikai Maebashi Hospital, Leukemia Research Center, Gunma, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Sakura
authors.affiliation: Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Onizuka
authors.affiliation: Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Kobayashi
authors.affiliation: Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Sawa
authors.affiliation: Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Eto
authors.affiliation: Division of Hematology, Kawasaki Medical School, Kurashiki, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Matsuhashi
authors.affiliation: Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kato
authors.affiliation: Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Ichinohe
authors.affiliation: Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.|Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Atsuta
authors.affiliation: Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Miyamura
mesh_terms: D000017:ABO Blood-Group System / Q000235:genetics; D000367:Age Factors; D000368:Aged; D001792:Blood Platelets; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D002423:Cause of Death; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology; D006680:HLA Antigens / Q000235:genetics; D006648:Histocompatibility; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000628:therapy; D009504:Neutrophils; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy; D016016:Proportional Hazards Models; D012008:Recurrence; D012720:Severity of Illness Index; D035781:Siblings; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D006680:HLA Antigens