OUTCOME OF CORD-BLOOD TRANSPLANTATION FROM RELATED AND UNRELATED DONORS

Background Cord-blood banks have increased the use of cord-blood trans plantation in patients with hematologic disorders. We have established a registry containing information on the outcome of cord-blood transp lantation. Methods We sent questionnaires to 45 transplantation center s for information on patients receiving cord-blood transplants from 19 88 to 1996. Reports on 143 transplantations, performed at 45 centers, were studied, and the responses were analyzed separately according to whether the donor was related or unrelated to the recipient. Results A mong 78 recipients of cord blood from related donors, the Kaplan-Meier estimate of survival at one year was 63 percent. Younger age, lower w eight, transplants from HLA-identical donors, and cytomegalovirus-nega tive serologic results in the recipient were favorable prognostic fact ors. Graft-versus-host disease of at least grade II occurred at estima ted rates of 9 percent in 60 recipients of HLA-matched cord blood and 50 percent in 18 recipients of HLA-mismatched cord blood. Neutrophil e ngraftment was associated with an age of less than six years (P = 0.02 ) and a weight of less than 20 kg (P = 0.02), and it occurred in 85 pe rcent of patients receiving 37 million or more nucleated cells per kil ogram of body weight. Among 65 patients who received cord blood from u nrelated donors, the Kaplan-Meier estimate of survival at one year was 29 percent. Cytomegalovirus-negative serologic status in these recipi ents was associated with improved survival (P = 0.03) and was the most important predictor of graft-versus-host disease (P = 0.04). Neutroph il recovery occurred in 94 percent of the patients who received 37 mil lion or more nucleated cells per kilogram from unrelated donors. Concl usions Cord blood is a feasible alternative source of hematopoietic st em cells for pediatric and some adult patients with major hematologic disorders, particularly if the donor and the recipient are related. (C ) 1997, Massachusetts Medical Society.