Allogeneic hematopoietic cell transplantation for hematologic malignancy: relative risks and benefits of double umbilical cord blood

November 26, 2010

BlankBlood, 25 November 2010, Vol. 116, No. 22, pp. 4693-4699.

Prepublished online as a Blood First Edition Paper on August 4, 2010; DOI

10.1182/blood-2010-05-285304.

Allogeneic hematopoietic cell transplantation for hematologic malignancy:

relative risks and benefits of double umbilical cord blood

Claudio G. Brunstein1, A. Gutman2, J. Weisdorf1, Ann E.

Woolfrey2, Todd E. DeFor1, Theodore A. Gooley2, R. Verneris1, Frederick

R. Appelbaum2, E. Wagner1,*, and Colleen Delaney2,*

1 University of Minnesota Medical Center, Minneapolis, MN; and 2 Fred Hutchison

Cancer Research Center, Seattle, WA

Effectiveness of double umbilical cord blood (dUCB) grafts relative to

conventional marrow and mobilized peripheral blood from related and unrelated

donors has yet to be established. We studied 536 patients at the Fred Hutchinson

Cancer Research Center and University of Minnesota with malignant disease who

underwent transplantation with an human leukocyte antigen (HLA)–matched related

donor (MRD, n = 204), HLA allele–matched unrelated donor (MUD, n = 152) or

1-antigen–mismatched unrelated adult donor (MMUD, n = 52) or 4-6/6 HLA matched

dUCB (n = 128) graft after myeloablative conditioning. Leukemia-free survival at

5 years was similar for each donor type (dUCB 51% [95% confidence interval (CI),

41%-59%]; MRD 33% [95% CI, 26%-41%]; MUD 48% [40%-56%]; MMUD 38% [95% CI,

25%-51%]). The risk of relapse was lower in recipients of dUCB (15%, 95% CI,

9%-22%) compared with MRD (43%, 95% CI, 35%-52%), MUD (37%, 95% CI, 29%-46%) and

MMUD (35%, 95% CI, 21%-48%), yet nonrelapse mortality was higher for dUCB (34%,

95% CI, 25%-42%), MRD (24% (95% CI, 17%-39%), and MUD (14%, 95% CI, 9%-20%). We

conclude that leukemia-free survival after dUCB transplantation is comparable

with that observed after MRD and MUD transplantation. For patients without an

available HLA matched donor, the use of 2 partially HLA-matched UCB units is a

suitable alternative.

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