Esperanza B. Papadopoulos, Andromachi Scaradavou, Juliet N. Barker, Sean M. Devlin, Sergio Giralt, Nancy A. Kernan, Richard J. O'Reilly, Marcel R.M. van den Brink, Katharine C. Hsu, Roni Tamari, Doris M. Ponce, Miguel-Angel Perales, James W. Young, Ann A. Jakubowski, Hugo Castro-Malaspina, Patrick Hilden, Marissa Lubin, Parastoo B. Dahi, Guenther Koehne, Craig S. Sauter, and Molly Maloy
Double-unit cord blood (DCB) grafts are a rapidly available stem cell source for adults with high-risk leukemias. However, how disease-free survival (DFS) after DCB transplantation (DCBT) compares to that of unrelated donor transplantation (URDT) is not fully established. We analyzed 166 allograft recipients (66 8/8 HLA–matched URDT, 45 7/8 HLA–matched URDT, and 55 DCBT) ages 16 to 60 years with high-risk acute leukemia or chronic myelogenous leukemia (CML). URDT and DCBT recipients were similar except DCBT recipients were more likely to have lower weight and non-European ancestry and to receive intermediate-intensity conditioning. All URDT recipients received a CD34+ cell–selected (T cell–depleted) graft. Overall, differences between the 3-year transplantation-related mortality were not significant (8/8 URDT, 18%; 7/8 URDT, 39%; and DCBT, 24%; P = .108), whereas the 3-year relapse risk was decreased after DCBT (8/8 URDT, 23%; 7/8 URDT, 20%; and DCBT 9%, P = .037). Three-year DFS was 57% in 8/8 URDT, 41% in 7/8 URDT, and 68% in DCBT recipients (P = .068), and the 3-year DFS in DCBT recipients was higher than that of 7/8 URDT recipients (P = .021). In multivariate analysis in acute leukemia patients, factors adversely associated with DFS were female gender (hazard ratio [HR], 1.68; P = .031), diagnosis of acute lymphoblastic leukemia (HR, 2.09; P = .004), and 7/8 T cell–depleted URDT (HR, 1.91; P = .037). High DFS can be achieved in adults with acute leukemia and CML with low relapse rates after DCBT. Our findings support performing DCBT in adults in preference to HLA-mismatched T cell–depleted URDT and suggest DCBT is a readily available alternative to T cell–depleted 8/8 URDT, especially in patients requiring urgent transplantation.