Outcomes after transplantation of cord blood or bone marrow from unrelated donors in adults with leukemia

Mary J. Laughlin, Mary Eapen, Pablo Rubinstein, John E. Wagner, Mei Jei Zhang, Richard E. Champlin, Cladd Stevens, Juliet N. Barker, Robert P. Gale, Hillard M. Lazarus, David I. Marks, Jon J. Van Rood, Andromachi Scaradavou, Mary M. Horowitz

Research output: Contribution to journalArticlepeer-review

953 Scopus citations


BACKGROUND: Data regarding the outcome of cord-blood transplantation in adults are scant, despite the fact that these grafts are increasingly used in adults. METHODS: We compared the outcomes of the transplantation of hematopoietic stem cells from unrelated donors in adults with leukemia who had received cord blood that was mismatched for one HLA antigen (34 patients) or two antigens (116 patients), bone marrow that had one HLA mismatch (83 patients), and HLA-matched bone marrow (367 patients). We used Cox proportional-hazards models to analyze the data. RESULTS: Cord-blood recipients were younger and more likely to have advanced leukemia than were bone marrow recipients, and they received lower doses of nucleated cells. Hematopoietic recovery was slower with transplantation of mismatched bone marrow and cord blood than with matched marrow transplantations. Acute graft-versus-host disease (GVHD) was more likely to occur after mismatched marrow transplantation, and chronic GVHD was more likely to occur after cord-blood transplantation. The rates of treatment-related mortality, treatment failure, and overall mortality were lowest among patients who received matched marrow transplants. Patients who received mismatched bone marrow transplants and those who received mismatched cord-blood transplants had similar rates of treatment-related mortality (P=0.96), treatment failure (P=0.69), and overall mortality (P=0.62). There were no differences in the rate of recurrence of leukemia among the groups. There were no differences in outcome after cord-blood transplantation between patients with one HLA mismatch and those with two HLA mismatches. CONCLUSIONS: HLA-mismatched cord blood should be considered an acceptable source of hematopoietic stem-cell grafts for adults in the absence of an HLA-matched adult donor.

Original languageEnglish (US)
Pages (from-to)2265-2275
Number of pages11
JournalNew England Journal of Medicine
Issue number22
StatePublished - Nov 25 2004

Bibliographical note

Funding Information:
We thank K. Rudolph and E. Steingrimsson for providing sequence data prior to publication, T. Hoey for providing bcd protein, and A. Courey and F. Pignoni for helpful comments on the manuscript. This work was supported by grants from the National Institutes of Health and American Cancer Society to J.A.L.


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