Comparison of Unrelated Cord Blood Transplantation and HLA-Mismatched Unrelated Bone Marrow Transplantation for Adults with Leukemia

Atsuta, Yoshiko; Morishima, Yasuo; Suzuki, Ritsuro; Nagamura-Inoue, Tokiko; Taniguchi, Shuichi; Takahashi, Satoshi; Kai, Shunro; Sakamaki, Hisashi; Kouzai, Yasushi; Kobayashi, Naoki; Fukuda, Takahiro; Azuma, Hiroshi; Takanashi, Minoko; Mori, Takehiko; Tsuchida, Masahiro; Kawase, Takakazu; Kawa, Keisei; Kodera, Yoshihisa; Kato, Shunichi; for the Japan Marrow Donor Program and the Japan Cord Blood Bank Network,

doi:10.1016/j.bbmt.2011.10.008

« Previous Next »Biology of Blood and Marrow Transplantation
Volume 18, Issue 5 , Pages 780-787, May 2012

Comparison of Unrelated Cord Blood Transplantation and HLA-Mismatched Unrelated Bone Marrow Transplantation for Adults with Leukemia

Yoshiko Atsuta
- Department of HSCT Data Management/Biostatistics Nagoya University Graduate School of Medicine, Nagoya, Japan
- Correspondence and reprint requests: Yoshiko Atsuta, MD, PhD, Department of Hematopoietic Stem Cell Transplantation Data Management/Biostatistics, Nagoya University School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku Nagoya 461-0047, Japan.
Yasuo Morishima
- Department of Hematology and Cell Therapy Aichi Cancer Center Hospital, Nagoya, Japan
- Y.M. and S. Kato share senior authorship.
Ritsuro Suzuki
- Department of HSCT Data Management/Biostatistics Nagoya University Graduate School of Medicine, Nagoya, Japan
Tokiko Nagamura-Inoue
- Department of Cell Processing & Transfusion, Research Hospital The Institute of Medical Science, The University of Tokyo, and Tokyo Cord Blood Bank Tokyo, Tokyo, Japan
Shuichi Taniguchi
- Department of Hematology Toranomon Hospital, Tokyo, Japan
Satoshi Takahashi
- Department of Molecular Therapy The Institute of Medical Science The University of Tokyo, Tokyo, Japan
Shunro Kai
- Department of Transfusion Medicine Hyogo College of Medicine, Nishinomiya, Japan
Hisashi Sakamaki
- Division of Hematology Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
Yasushi Kouzai
- Department of Transfusion Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
Naoki Kobayashi
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
Takahiro Fukuda
- Hematopoietic Stem Cell Transplantation Unit National Cancer Center Hospital, Tokyo, Japan
Hiroshi Azuma
- Hokkaido Red Cross Blood Center, Sapporo, Japan
Minoko Takanashi
- The Japanese Red Cross Tokyo Blood Center, Tokyo, Japan
Takehiko Mori
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
Masahiro Tsuchida
- Ibaraki Children’s Hospital, Mito, Japan
Takakazu Kawase
- Division of Epidemiology and Prevention, Aichi Cancer Center Hospital, Nagoya, Japan
Keisei Kawa
- Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
Yoshihisa Kodera
- BMT Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
Shunichi Kato
- Department of Cell Transplantation & Regenerative Medicine, Tokai University School of Medicine, Isehara, Japan
- Y.M. and S. Kato share senior authorship.
for the Japan Marrow Donor Program and the Japan Cord Blood Bank Network

Received 20 July 2011; accepted 9 October 2011. published online 17 October 2011.

Recent advances in unrelated cord blood transplantation (UCBT) and high-resolution typing of human leukocyte antigen (HLA) from an unrelated donor have increased choices in alternative donor/stem cell source selection. We assessed HLA-mismatched locus-specific comparison of the outcomes of 351 single-unit UCB and 1,028 unrelated bone marrow (UBM) adult recipients 16 years old or older at the time of transplantation who received first stem cell transplantation with myeloablative conditioning for acute leukemia or myelodysplastic syndromes. With adjusted analyses, HLA 0 to 2 mismatched UCBT showed similar overall mortality (relative risk [RR] = 0.85, 95% confidence interval [CI], 0.68-1.06; P = .149) compared with that of single-HLA-DRB1-mismatched UBMT. UCBT showed inferior neutrophil recovery (RR = 0.50, 95% CI, 0.42-0.60; P < .001), lower risk of acute graft-versus-host disease (RR = 0.55, 95% CI, 0.42-0.72; P < .001), and lower risk of transplantation-related mortality (RR = 0.68, 95% CI, 0.50-0.92; P = .011) compared with single-HLA-DRB1-mismatched UBMT. No significant difference was observed for risk of relapse (RR = 1.28, 95% CI, 0.93-1.76; P = .125). HLA 0 to 2 antigen-mismatched UCBT is a reasonable second alternative donor/stem cell source with a survival outcome similar to that of single-HLA-DRB1-mismatched or other 7 of 8 UBMT.

Key Words: Unrelated cord blood transplantation, HLA-mismatched unrelated bone marrow transplantation