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. 2020 May 26;4(10):2227-2235.
doi: 10.1182/bloodadvances.2020001554.

Adult cord blood transplant results in comparable overall survival and improved GRFS vs matched related transplant

Prashant Sharma  1 , Enkhtsetseg Purev  1 , Bradley Haverkos  1 , Daniel A Pollyea  1 , Evan Cherry  1 , Manali Kamdar  1 , Tomer Mark  1 , Peter Forsberg  1 , Daniel Sherbenou  1 , Andrew Hammes  2 , Rachel Rabinovitch  3 , Clayton A Smith  1 , Jonathan A Gutman  1
Affiliations

Adult cord blood transplant results in comparable overall survival and improved GRFS vs matched related transplant

Prashant Sharma et al. Blood Adv. .

Abstract

We compared outcomes among adult matched related donor (MRD) patients undergoing peripheral blood stem cell transplantation and adult patients undergoing double unit cord blood transplantation (CBT) at our center between 2010 and 2017. A total of 190 CBT patients were compared with 123 MRD patients. Median follow-up was 896 days (range, 169-3350) among surviving CBT patients and 1262 days (range, 249-3327) among surviving MRD patients. Comparing all CBT with all MRD patients, overall survival (OS) was comparable (P = .61) and graft-versus-host disease (GVHD) relapse-free survival (GRFS) was significantly improved among CBT patients (P = .0056), primarily because of decreased moderate to severe chronic GVHD following CBT (P < .0001; hazard ratio [HR], 3.99; 95% confidence interval [CI], 2.26-7.04). Among patients undergoing our most commonly used MRD and umbilical cord blood (CB) myeloablative regimens, OS was comparable (P = .136) and GRFS was significantly improved among CBT patients (P = .006). Cumulative incidence of relapse trended toward decreased in the CBT group (P = .075; HR, 1.85; CI 0.94-3.67), whereas transplant-related mortality (TRM) was comparable (P = .55; HR, 0.75; CI, 0.29-1.95). Among patients undergoing our most commonly used nonmyeloablative regimens, OS and GRFS were comparable (P = .158 and P = .697). Cumulative incidence of both relapse and TRM were comparable (P = .32; HR, 1.35; CI, 0.75-2.5 for relapse and P = .14; HR, 0.482; CI, 0.18-1.23 for TRM). Our outcomes support the efficacy of CBT and suggest that among patients able to tolerate more intensive conditioning regimens at high risk for relapse, CB may be the preferred donor source.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Cumulative incidence of GVHD.
Figure 2.
Figure 2.
Overall survival, GRFS, relapse, and TRM all patients.
Figure 3.
Figure 3.
Overall survival, GRFS, relapse, and TRM following myeloablative conditioning.
Figure 4.
Figure 4.
Overall survival, GRFS, relapse, and TRM following nonmyeloablative conditioning.
See this image and copyright information in PMC

References

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