Disease-specific analyses of unrelated cord blood transplantation compared with unrelated bone marrow transplantation in adult patients with acute leukemia.

We made a disease-specific comparison of unrelated cord blood (CB) recipients and human leukocyte antigen allele-matched unrelated bone marrow (BM) recipients among 484 patients with acute myeloid leukemia (AML; 173 CB and 311 BM) and 336 patients with acute lymphoblastic leukemia (ALL; 114 CB and 222 BM) who received myeloablative transplantations. In multivariate analyses, among AML cases, lower overall survival (hazard ratio [HR]=1.5; 95% confidence interval [CI], 1.0-2.0, P= .028) and leukemia-free survival (HR=1.5; 95% CI, 1.1-2.0, P= .012) were observed in CB recipients. The relapse rate did not differ between the 2 groups of AML (HR=1.2; 95% CI, 0.8-1.9, P= .38); however, the treatment-related mortality rate showed higher trend in CB recipients (HR=1.5; 95% CI, 1.0-2.3, P= .085). In ALL, there was no significant difference between the groups for relapse (HR=1.4, 95% CI, 0.8-2.4, P= .19) and treatment-related mortality (HR=1.0; 95% CI, 0.6-1.7, P= .98), which contributed to similar overall survival (HR=1.1; 95% CI, 0.7-1.6, P= .78) and leukemia-free survival (HR=1.2; 95% CI, 0.9-1.8, P= .28). Matched or mismatched single-unit CB is a favorable alternative stem cell source for patients without a human leukocyte antigen-matched related or unrelated donor. For patients with AML, decreasing mortality, especially in the early phase of transplantation, is required to improve the outcome for CB recipients.

[1]  J. Klein,et al.  Outcomes of transplantation of unrelated donor umbilical cord blood and bone marrow in children with acute leukaemia: a comparison study , 2007, The Lancet.

[2]  S. Asano,et al.  Comparative single-institute analysis of cord blood transplantation from unrelated donors with bone marrow or peripheral blood stem-cell transplants from related donors in adult patients with hematologic malignancies after myeloablative conditioning regimen. , 2007, Blood.

[3]  S. Asano,et al.  Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies. , 2004, Blood.

[4]  M. Labopin,et al.  Transplants of umbilical-cord blood or bone marrow from unrelated donors in adults with acute leukemia. , 2004, The New England journal of medicine.

[5]  M. Sanz.  Cord-blood transplantation in patients with leukemia--a real alternative for adults. , 2004, The New England journal of medicine.

[6]  J. Wagner,et al.  Outcomes after transplantation of cord blood or bone marrow from unrelated donors in adults with leukemia. , 2004, The New England journal of medicine.

[7]  V. Diehl,et al.  Outcome of allogeneic hematopoietic stem-cell transplantation in adult patients with acute lymphoblastic leukemia: no difference in related compared with unrelated transplant in first complete remission. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[8]  H. Inoko,et al.  The clinical significance of human leukocyte antigen (HLA) allele compatibility in patients receiving a marrow transplant from serologically HLA-A, HLA-B, and HLA-DR matched unrelated donors. , 2002, Blood.

[9]  Todd E DeFor,et al.  Searching for unrelated donor hematopoietic stem cells: availability and speed of umbilical cord blood versus bone marrow. , 2002, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[10]  A. Zander,et al.  Comparison of outcomes of unrelated bone marrow and umbilical cord blood transplants in children with acute leukemia. , 2001, Blood.

[11]  P W Lavori,et al.  Sample-size calculations for the Cox proportional hazards regression model with nonbinary covariates. , 2000, Controlled clinical trials.

[12]  J. Klein,et al.  Graft-versus-host disease in children who have received a cord-blood or bone marrow transplant from an HLA-identical sibling. Eurocord and International Bone Marrow Transplant Registry Working Committee on Alternative Donor and Stem Cell Sources. , 2000, The New England journal of medicine.

[13]  Robert Gray,et al.  A Proportional Hazards Model for the Subdistribution of a Competing Risk , 1999 .

[14]  T. Tarpey.  Self-Consistency and Principal Component Analysis , 1999 .

[15]  J Crowley,et al.  Estimation of failure probabilities in the presence of competing risks: new representations of old estimators. , 1999, Statistics in medicine.

[16]  J. Adamson,et al.  Outcomes among 562 recipients of placental-blood transplants from unrelated donors. , 1998, The New England journal of medicine.

[17]  Anajane G. Smith,et al.  Optimizing outcome after unrelated marrow transplantation by comprehensive matching of HLA class I and II alleles in the donor and recipient. , 1998, Blood.

[18]  Takato O. Yoshida,et al.  EFFECT OF MATCHING OF CLASS I HLA ALLELES ON CLINICAL OUTCOME AFTER TRANSPLANTATION OF HEMATOPOIETIC STEM CELLS FROM AN UNRELATED DONOR , 1998 .

[19]  C Anasetti,et al.  Bone marrow transplants from unrelated donors for patients with chronic myeloid leukemia. , 1998, The New England journal of medicine.

[20]  C. Chastang,et al.  Outcome of cord-blood transplantation from related and unrelated donors , 1997 .

[21]  J P Klein,et al.  Results of allogeneic bone marrow transplants for leukemia using donors other than HLA-identical siblings. , 1997, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[22]  J. Wagner,et al.  Successful transplantation of HLA-matched and HLA-mismatched umbilical cord blood from unrelated donors: analysis of engraftment and acute graft-versus-host disease. , 1996, Blood.

[23]  J. Kurtzberg,et al.  Placental blood as a source of hematopoietic stem cells for transplantation into unrelated recipients. , 1996, The New England journal of medicine.

[24]  E D Thomas,et al.  1994 Consensus Conference on Acute GVHD Grading. , 1995, Bone marrow transplantation.

[25]  M. Tanimoto,et al.  Low incidence of acute graft-versus-host disease by the administration of methotrexate and cyclosporine in Japanese leukemia patients after bone marrow transplantation from human leukocyte antigen compatible siblings; possible role of genetic homogeneity. The Nagoya Bone Marrow Transplantation Group , 1989, Blood.

[26]  A. Zander,et al.  transplants in children with acute leukemia Comparison of outcomes of unrelated bone marrow and umbilical cord blood , 2011 .

[27]  Y. Kodera,et al.  Risk and prognostic factors for Japanese patients with chronic graft-versus-host disease after bone marrow transplantation , 2006, Bone Marrow Transplantation.

[28]  K. Kawa,et al.  Analysis of 500 bone marrow transplants from unrelated donors (UR-BMT) facilitated by the Japan Marrow Donor Program: confirmation of UR-BMT as a standard therapy for patients with leukemia and aplastic anemia , 1999, Bone Marrow Transplantation.

[29]  C. Chastang,et al.  Outcome of cord-blood transplantation from related and unrelated donors. Eurocord Transplant Group and the European Blood and Marrow Transplantation Group. , 1997, The New England journal of medicine.

[30]  R. Gray.  A Class of $K$-Sample Tests for Comparing the Cumulative Incidence of a Competing Risk , 1988 .