title: Chronic graft versus host disease burden and late transplant complications are lower following adult double cord blood versus matched unrelated donor peripheral blood transplantation.
abstract: Adult umbilical cord blood transplantation (CBT) has emerged as an important option for patients lacking matched related (MRD) and matched unrelated donors (MUD). We compared chronic GVHD (cGVHD) incidence, immunosuppression burden and late infections and hospitalizations in consecutive patients undergoing CBT (n=51) versus peripheral blood MUD transplant (n=57) at our center between June 2009 and April 2014. At 3 years post transplantation, the cumulative incidence (CI) of moderate to severe cGVHD was 44% following MUD versus 8% following CBT (P=0.0006) and CI of any cGVHD was 68% following MUD versus 32% following CBT (P=0.0017). Median time to being off immunosuppression among CB patients was 268 days versus not reached among MUD patients (P<0.0001). Late infections and late hospitalized days were reduced in CB patients (P=0.1 and <0.001, respectively). Three-year CI of transplant-related mortality (TRM) and relapse as well as 3-year overall survival (OS) were similar following CB and MUD transplantation. We demonstrate a significantly lower incidence of cGVHD, immunosuppression burden and late complication rate following UCB versus peripheral blood MUD transplant without decreased OS, increased relapse or early TRM. Combined with the rapid availability of UCB, these findings have led our center to move primarily to UCB over peripheral blood MUD when a MRD is not available.
authors.affiliation: Division of Hematology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Gutman
authors.affiliation: Division of Hematology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA.
authors.forename: K
authors.initials: K
authors.lastname: Ross
authors.affiliation: Division of Hematology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA.
authors.forename: C
authors.initials: C
authors.lastname: Smith
authors.affiliation: Division of Hematology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA.
authors.forename: H
authors.initials: H
authors.lastname: Myint
authors.affiliation: Division of Hematology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA.
authors.forename: C-K
authors.initials: CK
authors.lastname: Lee
authors.affiliation: Division of Medical Oncology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Salit
authors.affiliation: Division of Medical Oncology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: F
authors.initials: F
authors.lastname: Milano
authors.affiliation: Division of Medical Oncology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Delaney
authors.affiliation: Division of Hematology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA.
authors.forename: D
authors.initials: D
authors.lastname: Gao
authors.affiliation: Division of Hematology, Department of Medicine, University of Colorado Denver, Aurora, CO, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Pollyea
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality / Q000592:standards; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality / Q000592:standards; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy; D015994:Incidence; D007239:Infections; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D061349:Unrelated Donors; D055815:Young Adult