Unrelated Cord Blood Transplant is An Alternative for Adults Lacking HLA-matched Donor

Unrelated cord blood transplantation is an alternative for adults with hematological malignancies lacking an HLA-matched donor.

"We analyzed outcomes and risk factors after unrelated cord blood transplantation (CBT) in adults with hematologic malignancies. One hundred and seventy-one patients were transplanted after 1997. Their median age was 29 years (15-55), and the median follow-up time was 18 months (1-71)," scientists in France report

According to W. Arcese and colleagues at Hospital St. Louis in Paris, "Most patients had acute or chronic leukemia (n=142, 83%), 91 (53%) were transplanted in advanced phase and an autologous transplant had failed in 32 (19%).

"Most patients (87%) received an HILA-mismatched cord blood unit with 1-2 HLA disparities. At infusion, the median number of nucleated cells and CD34+ cells was 2.1x107/kg and 1x105/kg, respectively."

"The cumulative incidence of neutrophil recovery at day 60 was 72±3% with a median of 28 days (11-57). A higher neutrophil count and use of hematopoietic growth factors were independently associated with faster neutrophil recovery," researchers said.

"The cumulative incidence of grade II-IV acute graft-versus-host disease was 32±4% and this complication was not associated with the number of HLA mismatches. The 2-year cumulative incidence of chronic graft-versus-host disease, transplant related-mortality and relapse were 36±10%, 51±4% and 22±4%, respectively.

"At 2-years," continued the authors, "disease-free-survival for patients transplanted in early, intermediate and advanced phases of disease was 41.9%, 34±10% and 18±4%, respectively. In multivariate analyses, advanced disease status was an adverse factor for relapse and disease-free survival."

Arcese concluded, "Unrelated CBT is a clear alternative for adults with hematological malignancies lacking an HLA-matched related or unrelated donor. The choice of units containing a higher neutrophil count and a policy of earlier transplantation are likely to provide better results."

Arcese and colleagues published their study in Haematologica - the Hematology Journal (Arcese et al. Unrelated cord blood transplants in adults with hematologic malignancies. Haematologica, 2006;91(2):223-230).