Cord blood transplant reduces chronic GVHD, late infection rates

Adult umbilical cord blood transplantation produced lower rates of chronic graft-versus-host disease than peripheral blood transplants from matched, unrelated donors, according to a single institution study.

Further, cord blood transplantation reduced immunosuppression burden and incidence of late complications.

Umbilical cord blood has arisen as a potential donor source for patients without matched related or unrelated donors, with studies showing similar OS outcomes in adult and pediatric populations. However, many treatment centers continue to prioritize matched unrelated donor transplantations, owing to concerns about adverse events and delayed immune reconstitution.

“A lot of centers reserved cord blood transplants for their worst cases, and so it got an early reputation for being less successful,” Jonathan A. Gutman, MD, associate professor of medicine, clinical director of allogeneic stem cell transplantation and co-medical director of the cord blood bank at University of Colorado School of Medicine, said in a press release. “It also costs a bit more — it takes cord blood cells a little longer to get going, and so patients need to be supported a little longer.”

Chronic graft-versus-host disease (GVHD) is a frequent cause of morbidity and mortality in long-term transplant survivors.

Gutman and colleagues compared the incidence of chronic GVHD, as well as the immunosuppression burden and late infection rates, among patients who underwent umbilical cord blood transplantation or matched unrelated peripheral blood transplantation.

The analysis included data from consecutive patients treated at University of Colorado Hospital between June 2009 and April 2014. Fifty-one patients (median age, 58 years; range, 22-73) underwent umbilical cord blood transplantation and 57 patients (median age, 54 years; range, 18-72) underwent matched unrelated peripheral blood transplantation.

The cumulative incidence of chronic GVHD at 3 years was 44% after matched unrelated donor transplantation and 8% after cord blood transplantation (P = .0006).

The cumulative incidence of any chronic GVHD was 68% for matched unrelated donor transplantation and 32% for cord blood transplantation (P = .0017).

Immunosuppression withdrawal occurred more rapidly after cord blood transplantation (P < .0001), with a median time to discontinuation of immunosuppression of 268 days. Median time to being off immunosuppression was not reached in the matched unrelated donor group.

The median time to chronic GVHD was 210 days (range, 108-490) in the cord blood transplantation group and 225 days (range, 83-803) in the matched unrelated donor group.

One patient who underwent cord blood transplantation died of chronic GVHD complications and remained on immunosuppression at the time of death. Five patients in the matched unrelated donor group died of chronic GVHD complications and two died of relapse; all were on immunosuppression at the time of death.

A descriptive analysis of late infection and hospitalization rates began 90 days after transplantation, after excluding patients who died or relapsed (cord blood, n = 8; matched unrelated, n = 10), experienced graft failure (cord blood, n = 3; matched unrelated, n = 5), or underwent rapid suppression or persistent disease (n = 1 for both).

Patients who underwent cord blood transplantation had fewer infectious episodes (19 vs. 29) and fewer hospitalized days (median, 535 days vs. 825 days; P < .001).

Both groups had similar cumulative incidences of treatment-related deaths (cord blood, 25%; matched unrelated, 24%), relapse (cord blood, 22%; matched unrelated, 24%) and OS (cord blood, 54%; matched unrelated, 52%).

Study limitations include the retrospective design, the use of a small and heterogeneous population, and the use of different GVHD prophylactic strategies.

“Our results show that, long term, receiving a cord blood transplant is less likely than receiving a transplant from an unrelated, matched donor to result in GVHD,” Gutman said. “As a result, we have chosen to use cord blood as our first choice in cases where a matched, related donor is unavailable.” – by Cameron Kelsall

Disclosure: The researchers report no relevant financial disclosures.