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.
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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@mcw.edu.
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