Umbilical-cord blood transplantation an alternative to HLA-matched unrelated donor transplant in adults with acute leukemia

When a transplant is needed urgently, and there is no HLA-matched unrelated adult donor available, the use of umbilical-cord blood may be an alternative to transplantation with 8/8 and 7/8 HLA-matched peripheral blood progenitor cells and bone marrow.

“Clinicians should not waste time if it is thought that a patient is in imminent danger of progression, and should move towards cord-blood transplantation as long as a four-of-six HLA-matched unit is identified,” Paul Szabolcs, MD, assistant professor of pediatrics and immunology at Duke University Medical Center, in Durham, N.C., wrote in an accompanying editorial.

In a retrospective analysis, researchers analyzed data from patients aged 16 years or older who underwent transplantation between 2002 and 2006: 165 had umbilical-cord blood transplantation, 888 had peripheral blood progenitor cell transplantation and 472 had bone marrow transplantation.

Although leukemia-free survival was comparable between all groups, transplant-related mortality was higher in the group who had umbilical-cord blood transplantation vs. those who had 8/8 allele-matched peripheral blood progenitor cell transplantation (HR=1.62; 95% CI, 1.18-2.23) or bone marrow transplantation (HR=1.69; 95% CI, 1.19-2.39).

When compared with 8/8 allele-matched peripheral blood progenitor cell transplantation, grade-2 to grade-4 acute (HR=0.57; 95% CI, 0.42-0.77) and chronic (HR=0.38; 95% CI, 0.27-0.53) graft-versus-host disease were lower for those who had umbilical-cord blood transplantation.

When compared with 8/8 allele-matched bone marrow transplantation, only chronic GVH disease was lower for patients who underwent umbilical-cord blood transplantation (HR=0.63; 95% CI, 0.44-0.90).

Eapen M. Lancet Oncol. 2010;doi:10.1016/S1470-2045(10)70127-3.