Cord-Blood Transplantation in Patients with Minimal Residual Disease.
The majority of patients in need of a hematopoietic-cell transplant do not have a matched related donor. Data are needed to inform the choice among various alternative donor-cell sources.



In this retrospective analysis, we compared outcomes in 582 consecutive patients with acute leukemia or the myelodysplastic syndrome who received a first myeloablative hematopoietic-cell transplant from an unrelated cord-blood donor (140 patients), an HLA-matched unrelated donor (344), or an HLA-mismatched unrelated donor (98).



The relative risks of death and relapse between the cord-blood group and the two other unrelated-donor groups appeared to vary according to the presence of minimal residual disease status before transplantation. Among patients with minimal residual disease, the risk of death was higher in the HLA-mismatched group than in the cord-blood group (hazard ratio, 2.92; 95% confidence interval [CI], 1.52 to 5.63; P=0.001); the risk was also higher in the HLA-matched group than in the cord-blood group but not significantly so (hazard ratio, 1.69; 95% CI, 0.94 to 3.02; P=0.08). Among patients without minimal residual disease, the hazard ratios were lower (hazard ratio in the HLA-mismatched group, 1.36; 95% CI, 0.76 to 2.46; P=0.30; hazard ratio in the HLA-matched group, 0.78; 95% CI, 0.48 to 1.28; P=0.33). The risk of relapse among patients with minimal residual disease was significantly higher in the two unrelated-donor groups than in the cord-blood group (hazard ratio in the HLA-mismatched group, 3.01; 95% CI, 1.22 to 7.38; P=0.02; hazard ratio in the HLA-matched group, 2.92; 95% CI, 1.34 to 6.35; P=0.007). Among patients without minimal residual disease, the magnitude of these associations was lower (hazard ratio in the HLA-mismatched group, 1.28; 95% CI, 0.51 to 3.25; P=0.60; hazard ratio in the HLA-matched group, 1.30; 95% CI, 0.65 to 2.58; P=0.46).



Our data suggest that among patients with pretransplantation minimal residual disease, the probability of overall survival after receipt of a transplant from a cord-blood donor was at least as favorable as that after receipt of a transplant from an HLA-matched unrelated donor and was significantly higher than the probability after receipt of a transplant from an HLA-mismatched unrelated donor. Furthermore, the probability of relapse was lower in the cord-blood group than in either of the other groups.
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle.
Filippo
F
Milano
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle.
Ted
T
Gooley
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle.
Brent
B
Wood
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle.
Ann
A
Woolfrey
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle.
Mary E
ME
Flowers
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle.
Kristine
K
Doney
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle.
Robert
R
Witherspoon
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle.
Marco
M
Mielcarek
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle.
Joachim H
JH
Deeg
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle.
Mohamed
M
Sorror
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle.
Ann
A
Dahlberg
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle.
Brenda M
BM
Sandmaier
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle.
Rachel
R
Salit
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle.
Effie
E
Petersdorf
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle.
Frederick R
FR
Appelbaum
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington - both in Seattle.
Colleen
C
Delaney
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects; D005260:Female; D005434:Flow Cytometry; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000628:therapy*; D018365:Neoplasm, Residual / Q000401:mortality / Q000628:therapy*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D014184:Transplantation, Homologous; D055815:Young Adult