Umbilical blood-cord allogeneic hematopoietic-cell transplant donations improve survival of some patients with acute leukemia or myelodysplastic syndrome, according to an article published in The New England Journal of Medicine.1

Patients who require these transplants are best off with donations from human leukocyte antigen (HLA)-identical siblings, though this option is available in only about 30% of cases. Other options include HLA-matched unrelated donors (available to only half of patients without an HLA-identical sibling), unrelated donors mismatched for only 1 allele, and umbilical cord-blood donors.

To identify the best option, researchers enrolled 582 patients to a retrospective analysis, in which 344 received a transplant from an HLA-matched donor, 98 received a transplant from an HLA-mismatched donor, and 140 received a transplant from an umbilical cord donor. Thirty-one percent of patients in the HLA-matched group had minimal residual disease, as did 39% in the mismatched group, and 33% in the cord-blood group.

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Unadjusted 4-year overall survival estimates were 63% in the matched group, 49% in the mismatched group, and 71% in the cord-blood group. Unadjusted 4-year risk of relapse was 24% in the HLA-matched group, 25% in the HLA-mismatched group, and 15% in the cord-blood group.

Patients with minimal residual disease, however, were less likely to relapse than in the other groups.

The authors conclude that overall survival is improved for patients with acute leukemia or myelodysplastic syndrome, particularly with minimal residual disease, if hematopoietic-cell transplant donations are received via umbilical cord-blood.

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It is noted, however, that patients in the cord-blood group were, on average, younger, and that time to transplantation can be a major factor in overall survival.

Reference

  1. Milano F, Gooley T, Wood, B, et al. Cord-blood transplantation in patients with minimal residual disease. N Engl J Med. 2016; 375:944-953 doi: 10.1056/NEJMoa1602074

Topics:

Hematologic Cancers Leukemia