Outcome of Cord-Blood Transplantation from Related and Unrelated Donors
Eliane Gluckman, M.D., Vanderson Rocha, M.D., Agnès Boyer-Chammard, M.D., Franco Locatelli, M.D., William Arcese, M.D., Ricardo Pasquini, M.D., Juan Ortega, M.D., Gérard Souillet, M.D., Euripedes Ferreira, M.D., Jean-Philippe Laporte, M.D., Manuel Fernandez, M.D., Claude Chastang, M.D., Ph.D., for The Eurocord Transplant Group and the European Blood and Marrow Transplantation Group
Background Cord-blood banks have increased the use of cord-bloodtransplantation in patients with hematologic disorders. We haveestablished a registry containing information on the outcomeof cord-blood transplantation.
Methods We sent questionnaires to 45 transplantation centersfor information on patients receiving cord-blood transplantsfrom 1988 to 1996. Reports on 143 transplantations, performedat 45 centers, were studied, and the responses were analyzedseparately according to whether the donor was related or unrelatedto the recipient.
Results Among 78 recipients of cord blood from related donors,the Kaplan–Meier estimate of survival at one year was63 percent. Younger age, lower weight, transplants from HLA-identicaldonors, and cytomegalovirus-negative serologic results in therecipient were favorable prognostic factors. Graft-versus-hostdisease of at least grade II occurred at estimated rates of9 percent in 60 recipients of HLA-matched cord blood and 50percent in 18 recipients of HLA-mismatched cord blood. Neutrophilengraftment was associated with an age of less than six years(P = 0.02) and a weight of less than 20 kg (P = 0.02), and itoccurred in 85 percent of patients receiving 37 million or morenucleated cells per kilogram of body weight. Among 65 patientswho received cord blood from unrelated donors, the Kaplan–Meierestimate of survival at one year was 29 percent. Cytomegalovirus-negativeserologic status in these recipients was associated with improvedsurvival (P = 0.03) and was the most important predictor ofgraft-versus-host disease (P = 0.04). Neutrophil recovery occurredin 94 percent of the patients who received 37 million or morenucleated cells per kilogram from unrelated donors.
Conclusions Cord blood is a feasible alternative source of hematopoieticstem cells for pediatric and some adult patients with majorhematologic disorders, particularly if the donor and the recipientare related.
Source Information
From the Hôpital Saint-Louis, Paris (E.G., V.R., A.B.-C., C.C.); the University of Pavia, Pavia, Italy (F.L.); the University La Sapienza, Rome (W.A.); the Hospital de Clinicas, Curitiba, Brazil (R.P.); the Hospital Infantil Vall d'Hebron, Barcelona, Spain (J.O.); the Hôpital Debrousse, Lyons, France (G.S.); the Hospital Albert Einstein, São Paulo, Brazil (E.F.); the Hôpital Saint-Antoine, Paris (J.-P.L.); and the Clinica Puerta de Hierro, Madrid (M.F.).
Address reprint requests to Dr. Gluckman at the Hematology Bone Marrow Transplant Unit, Hôpital Saint-Louis, 1 ave. Claude Vellefaux, 75475 Paris CEDEX 10, France.
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