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Previous Volume 351:2265-2275 November 25, 2004 Number 22 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Perspective by Steinbrook, R. Editorial by Sanz, M. A. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Data regarding the outcome of cord-blood transplantation in adults are scant, despite the fact that these grafts are increasingly used in adults.

Methods We compared the outcomes of the transplantation of hematopoietic stem cells from unrelated donors in adults with leukemia who had received cord blood that was mismatched for one HLA antigen (34 patients) or two antigens (116 patients), bone marrow that had one HLA mismatch (83 patients), and HLA-matched bone marrow (367 patients). We used Cox proportional-hazards models to analyze the data.

Results Cord-blood recipients were younger and more likely to have advanced leukemia than were bone marrow recipients, and they received lower doses of nucleated cells. Hematopoietic recovery was slower with transplantation of mismatched bone marrow and cord blood than with matched marrow transplantations. Acute graft-versus-host disease (GVHD) was more likely to occur after mismatched marrow transplantation, and chronic GVHD was more likely to occur after cord-blood transplantation. The rates of treatment-related mortality, treatment failure, and overall mortality were lowest among patients who received matched marrow transplants. Patients who received mismatched bone marrow transplants and those who received mismatched cord-blood transplants had similar rates of treatment-related mortality (P=0.96), treatment failure (P=0.69), and overall mortality (P=0.62). There were no differences in the rate of recurrence of leukemia among the groups. There were no differences in outcome after cord-blood transplantation between patients with one HLA mismatch and those with two HLA mismatches.

Conclusions HLA-mismatched cord blood should be considered an acceptable source of hematopoietic stem-cell grafts for adults in the absence of an HLA-matched adult donor.

Source Information

From the Case Comprehensive Cancer Center and University Hospitals of Cleveland Ireland Cancer Center, Cleveland (M.J.L., H.M.L.); the International Bone Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee (M.E., M.-J.Z., M.M.H); the National Cord Blood Program, New York Blood Center, New York (P.R., C.S., A.S.); the University of Minnesota Medical School, Minneapolis (J.E.W., J.N.B.); the M.D. Anderson Cancer Research Center, Houston (R.E.C.); the Center for Advanced Studies in Leukemia, Los Angeles (R.P.G.); the Adult Blood and Marrow Transplant Unit, United Bristol Health Care Trust, Bristol, United Kingdom (D.I.M.); and Leiden University Medical Center, Leiden, the Netherlands (J.J.R.).

Address reprint requests to Dr. Horowitz at the International Bone Marrow Transplant Registry, Medical College of Wisconsin, 8701 Watertown Plank Rd., P.O. Box 26509, Milwaukee, WI 53226, or at marymh{at}mcw.edu.

Full Text of this Article

Related Letters:

Umbilical-Cord Blood for Transplantation in Adults
Fernandez M. N., Regidor C., Cabrera R., Bandini G., Bonifazi F., Stanzani M., Laughlin M. J., Eapen M., Rubinstein P., Rocha V., Labopin M., Gluckman E., the Acute Leukemia Working Party of the European Blood and Marrow Transplant Group and the Eurocord–Netcord Registry
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N Engl J Med 2005; 352:935-937, Mar 3, 2005. Correspondence

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