Unrelated umbilical cord blood transplant for adult acute lymphoblastic leukemia in first and second complete remission: a comparison with allografts from adult unrelated donors.

Publication Type:

Journal Article

Source:

Haematologica (2013)

Keywords:

2013, Clinical Research Division, October 2013

Abstract:

Allogeneic hematopoietic cell transplantation has an established role in treating adult acute lymphoblastic leukemia with survival using adult unrelated donors approaching those of sibling donors. Our aim was to determine the role of mismatched unrelated cord blood grafts in transplantation for 802 adults with acute lymphoblastic leukemia in first or second complete remission. Using Cox regression we compared outcomes after 116 mismatched single or double cord blood, 546 peripheral blood progenitor-cells and 140, bone marrow. Patient and disease characteristics of recipients were similar except cord blood recipients were younger, more likely to be non-Caucasians and to have low white blood cell count at diagnosis. There were differences in donor-recipient human leukocyte antigen-match between the donor sources. Most adult donor transplants were matched at the allele-level considering human leukocyte antigen-A, -B, -C and DRB1. In contrast, most cord blood transplants were mismatched and considered antigen-level match; 57% were mismatched at 2- and 29% at 1-loci whereas only 29% of adult donor transplants were mismatched at 1 locus and none at 2-loci. There were no differences in the 3-year probabilities of survival between cord blood (44%), matched (44%) and mismatched (43%) adult donor transplants. Cord blood transplants had slower engraftment, less grade 2-4 acute but similar chronic graft-versus-host disease, relapse, and transplant-related mortality. Cord blood grafts achieved similar survival to matched or mismatched unrelated donor grafts and should be considered a valid alternative stem-cell source for adults with acute lymphoblastic leukemia in the absence of a matched unrelated adult donor.