Patients with acute leukemia, including acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML), may have similar progression-free survival (PFS) and overall survival (OS) rates with unrelated hematopoietic stem cell transplant (HSCT) or umbilical cord blood transplant (UCBT), according to an analysis published in Blood Reviews.1
The incidence of acute leukemias, especially ALL, is projected to grow worldwide over the next 10 years, with wide survival disparity depending on the patient’s country of origin. While HSCT is an effective treatment option, as few as 30% of patients will have a matched donor available. Unrelated donors with minimal human leukocyte antigen (HLA) mismatches are used in the absence of a matched donor, an option which can yield similar survival outcomes.
Another option is UCBT, which is widely available, though previous studies linked this treatment with higher infection rates than and inferior survival to unrelated HSCT. For this meta-analysis, researchers evaluated outcomes data from 9 studies consisting of 6762 patients with an acute leukemia to determine whether HSCT is superior to UCBT.
Of all included patients, 4736 underwent HSCT and 2026 underwent UCBT. The odds ratio (OR) for relapse was 1.03 (P = .847) with UBCT, the pooled OR for OS was 1.417 (P = .1), and the OR for PFS was 1.165 (P = .056).
The length of time to neutrophil and platelet recovery was, however, significantly longer among adults patients who underwent UCBT, suggesting that adults who undergo UCBT should be monitored closely for infection. The difference was not found among pediatric patients.
The authors concluded that “our data provide strong evidence to support increased use of cord blood transplants for both adults and children with acute leukemia.”