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Previous Volume 351:2276-2285 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 Promising results of cord-blood transplants from unrelated donors have been reported in adults.

Methods We compared outcomes in 682 adults with acute leukemia who received a hematopoietic stem-cell transplant from an unrelated donor: 98 received cord blood and 584 received bone marrow. The transplantations were performed from 1998 through 2002 and reported to Eurocord and the European Blood and Marrow Transplant Group.

Results Recipients of cord blood were younger than recipients of bone marrow (median, 24.5 vs. 32 years of age; P<0.001), weighed less (median, 58 vs. 68 kg; P<0.001), and had more advanced disease at the time of transplantation (52 percent vs. 33 percent, P<0.001). All marrow transplants were HLA matched, whereas 94 percent of cord-blood grafts were HLA mismatched (P<0.001). The median number of nucleated cells that were infused was 0.23x10⁸ per kilogram of the recipient's body weight for cord blood and 2.9x10⁸ per kilogram for bone marrow (P<0.001). Multivariate analysis showed lower risks of grade II, III, or IV acute graft-versus-host disease (GVHD) after cord-blood transplantation (relative risk, 0.57; 95 percent confidence interval, 0.37 to 0.87; P=0.01), but neutrophil recovery was significantly delayed (relative risk, 0.49; 95 percent confidence interval, 0.41 to 0.58; P<0.001). The incidence of chronic GVHD, transplantation-related mortality, relapse rate, and leukemia-free survival were not significantly different in the two groups.

Conclusions Cord blood from an unrelated donor is an alternative source of hematopoietic stem cells for adults with acute leukemia who lack an HLA-matched bone marrow donor.

Source Information

From Hôpital Saint-Louis (V.R., E.G.), and Hôpital Saint Antoine (M. Labopin), Assistance Publique des Hôpitaux de Paris and Paris University, Paris; Hospital Universitario La Fe, Valencia, Spain (G.S.); Università Tor Vergata, Rome (W.A.); Deutsche Klinik für Diagnostik, Wiesbaden, Germany (R.S.); Ospedale di Careggi, Florence, Italy (A.B.); University Hospital for Internal Medicine, Rigshospitalet, Copenhagen (N.J.); Helsinki University Central Hospital, Helsinki (T.R.); M.D. Anderson Cancer Center, Houston (M. de Lima); University of Freiburg, Freiburg, Germany (J.F.); and Ospedale San Martino, Genoa, Italy (F.F.).

Address reprint requests to Dr. Gluckman at Hôpital Saint-Louis, Hematology Bone Marrow Transplant Department, 1 Ave. Claude Vellefaux, 75475 Paris CEDEX 10, France, or at eliane.gluckman{at}sls.ap-hop-paris.fr.

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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