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Blood, 1 December 2004, Vol. 104, No. 12, pp. 3813-3820.
Prepublished online as a Blood First Edition Paper on July 27, 2004; DOI 10.1182/blood-2004-03-1001.
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TRANSPLANTATION
Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies
Satoshi Takahashi,
Tohru Iseki,
Jun Ooi,
Akira Tomonari,
Kashiya Takasugi,
Yoko Shimohakamada,
Toshiki Yamada,
Kaoru Uchimaru,
Arinobu Tojo,
Naoki Shirafuji,
Hideki Kodo,
Kenzaburo Tani,
Tsuneo Takahashi,
Takuhiro Yamaguchi, and
Shigetaka Asano
From the Division of Molecular Therapy, The Advanced Clinical Research Center and Division of Cell Processing, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan; and Department of Biostatistics/Epidemiology and Preventive Health Sciences, School of Health Sciences and Nursing, University of Tokyo, Tokyo, Japan.
Unrelated cord blood transplantation (CBT) has now become more common, but as yet there have been only a few reports on its outcome compared with bone marrow transplantation (BMT), especially for adults. We studied the clinical outcomes of 113 adult patients with hematologic malignancies who received unrelated BM transplants (n = 45) or unrelated CB transplants (n = 68). We analyzed the hematopoietic recovery, rates of graft-versus-host disease (GVHD), risks of transplantation-related mortality (TRM) and relapse, and disease-free survival (DFS) using Cox proportional hazards models. The time from donor search to transplantation was significantly shorter among CB transplant recipients (median, 2 months) than BM transplant recipients (median, 11 months; P < .01). Multivariate analysis demonstrated slow neutrophil (P < .01) and platelet (P < .01) recoveries in CBT patients compared with BMT patients. Despite rapid tapering of immunosuppressants after transplantation and infrequent use of steroids to treat severe acute GVHD, there were no GVHD-related deaths among CB transplant recipients compared with 10 deaths of 24 among BM transplant recipients. Unrelated CBT showed better TRM and DFS results compared with BMT (P = .02 and P < .01, respectively), despite the higher human leukocyte antigen mismatching rate and lower number of infused cells. These data strongly suggest that CBT could be safely and effectively used for adult patients with hematologic malignancies.
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