Disease-specific analyses of unrelated cord blood transplantation compared with unrelated bone marrow transplantation in adult patients with acute leukemia

We made a disease-specific comparison of unrelated cord blood (CB) recipients and human leukocyte antigen allele matched unrelated bone marrow (BM) recipients among 484 patients with acute myeloid leukemia (AML; 173 CB and 311 BM) and 336 patients with acute lymphoblastic leukemia (ALL; 114 CB and 222 BM) who received myeloablative transplantations. In multivariate analyses, among AML cases, lower overall survival (hazard ratio [HR] = 1.5; 95% confidence interval [CI], 1.0-2.0, P = .028) and leukemia-free survival (HR = 1.5; 95% CI, 1.1-2.0, P = .012) were observed in CB recipients. The relapse rate did not differ between the 2 groups of AML (HR = 1.2; 95% CI, 0.8-1.9, P = .38); however, the treatment-related mortality rate showed higher trend in CB recipients (HR = 1.5; 95% CI, 1.0-2.3, P = .085). In ALL, there was no significant difference between the groups for relapse (HR = 1.4, 95% CI, 0.8-2.4, P = .19) and treatment-related mortality (HR = 1.0; 95% CI, 0.6-1.7, P = .98), which contributed to similar overall survival (HR = 1.1; 95% CI, 0.7-1.6, P = .78) and leukemia-free survival (HR = 1.2; 95% CI, 0.9-1.8, P = .28). Matched or mismatched single-unit CB is a favorable alternative stem cell source for patients without a human leukocyte antigen-matched related or unrelated donor. For patients with AML, decreasing mortality, especially in the early phase of transplantation, is required to improve the outcome for CB recipients. (Blood. 2009; 113: 1631-1638)