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Volume 342:1846-1854 June 22, 2000 Number 25 Next

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ABSTRACT

Background Umbilical-cord blood as an alternative to bone marrow for hematopoietic stem-cell transplantation may lower the risk of graft-versus-host disease (GVHD).

Methods We studied the records of 113 recipients of cord blood from HLA-identical siblings from the period from 1990 through 1997 and compared them with the records of 2052 recipients of bone marrow from HLA-identical siblings during the same period. The study population consisted of children 15 years of age or younger. We compared the rates of GVHD, hematopoietic recovery, and survival using Cox proportional-hazards regression to adjust for potentially confounding factors.

Results Recipients of cord blood were younger than recipients of bone marrow (median age, 5 years vs. 8 years; P<0.001), weighed less (median weight, 17 kg vs. 26 kg; P<0.001), and were less likely to have received methotrexate for prophylaxis against GVHD (28 percent vs. 65 percent, P<0.001). Multivariate analysis demonstrated a lower risk of acute GVHD (relative risk, 0.41; P=0.001) and chronic GVHD (relative risk, 0.35; P=0.02) among recipients of cord-blood transplants. As compared with recovery after bone marrow transplantation, the likelihood of recovery of the neutrophil count and the platelet count was significantly lower in the first month after cord-blood transplantation (relative risk, 0.40 [P<0.001], and relative risk, 0.20 [P<0.001], respectively). Mortality was similar in the two groups (relative risk of death in the recipients of cord blood, 1.15; P=0.43).

Conclusions Recipients of cord-blood transplants from HLA-identical siblings have a lower incidence of acute and chronic GVHD than recipients of bone marrow transplants from HLA-identical siblings.

Source Information

From the Eurocord–Cord Blood Transplant Group, Hôpital Saint Louis and University of Paris, Paris (V.R., E.G.); the University of Minnesota School of Medicine, Minneapolis (J.E.W.); and the International Bone Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee (K.A.S., J.P.K., M.-J.Z., M.M.H.). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.

Address reprint requests to Dr. Horowitz at the IBMTR/ABMTR Statistical Center, Medical College of Wisconsin, P.O. Box 26509, Milwaukee, WI 53226; or at marymh{at}mcw.edu.

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