Transplants of umbilical-cord blood or bone marrow from unrelated donors in adults with acute leukemia

N Engl J Med. 2004 Nov 25;351(22):2276-85. doi: 10.1056/NEJMoa041469.


Background: Promising results of cord-blood transplants from unrelated donors have been reported in adults.

Methods: We compared outcomes in 682 adults with acute leukemia who received a hematopoietic stem-cell transplant from an unrelated donor: 98 received cord blood and 584 received bone marrow. The transplantations were performed from 1998 through 2002 and reported to Eurocord and the European Blood and Marrow Transplant Group.

Results: Recipients of cord blood were younger than recipients of bone marrow (median, 24.5 vs. 32 years of age; P<0.001), weighed less (median, 58 vs. 68 kg; P<0.001), and had more advanced disease at the time of transplantation (52 percent vs. 33 percent, P<0.001). All marrow transplants were HLA matched, whereas 94 percent of cord-blood grafts were HLA mismatched (P<0.001). The median number of nucleated cells that were infused was 0.23x10(8) per kilogram of the recipient's body weight for cord blood and 2.9x10(8) per kilogram for bone marrow (P<0.001). Multivariate analysis showed lower risks of grade II, III, or IV acute graft-versus-host disease (GVHD) after cord-blood transplantation (relative risk, 0.57; 95 percent confidence interval, 0.37 to 0.87; P=0.01), but neutrophil recovery was significantly delayed (relative risk, 0.49; 95 percent confidence interval, 0.41 to 0.58; P<0.001). The incidence of chronic GVHD, transplantation-related mortality, relapse rate, and leukemia-free survival were not significantly different in the two groups.

Conclusions: Cord blood from an unrelated donor is an alternative source of hematopoietic stem cells for adults with acute leukemia who lack an HLA-matched bone marrow donor.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Analysis of Variance
  • Bone Marrow Transplantation* / adverse effects
  • Bone Marrow Transplantation* / immunology
  • Bone Marrow Transplantation* / mortality
  • Cause of Death
  • Chronic Disease
  • Cord Blood Stem Cell Transplantation* / adverse effects
  • Cord Blood Stem Cell Transplantation* / mortality
  • Disease-Free Survival
  • Female
  • Fetal Blood / immunology
  • Fetal Blood / transplantation
  • Follow-Up Studies
  • Graft vs Host Disease / epidemiology
  • Graft vs Host Disease / etiology
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Hematopoietic Stem Cell Transplantation* / mortality
  • Histocompatibility Testing
  • Humans
  • Incidence
  • Leukemia / immunology
  • Leukemia / mortality
  • Leukemia / therapy*
  • Male
  • Middle Aged
  • Neutrophils / physiology
  • Recurrence
  • Registries
  • Retrospective Studies
  • Survival Analysis
  • Tissue Donors