A Meta-Analysis of Unrelated Donor Umbilical Cord Blood Transplantation versus Unrelated Donor Bone Marrow Transplantation in Adult and Pediatric Patients

Abstract

Several studies have compared the results of unrelated donor bone marrow transplantation (UBMT) and unrelated donor cord blood transplantation (UCBT). To objectively analyze these data, we performed a systematic review and meta-analysis of pooled data on comparative studies of UCBT and UBMT in patients requiring hematopoietic stem cell transplantation. Combining the studies, 161 children and 316 adults undergoing UCBT (mostly 1 or 2 antigen-mismatched), along with 316 children and 996 adults undergoing UBMT (almost entirely fully matched with the recipient), were analyzed. T-cell-depleted UBMT was excluded; where data were available, only fully matched UBMT was used in the analysis. Pooled comparisons of studies of UCBT and UBMT in children found that the incidence of chronic graft-versus-host disease (GVHD) was lower with UCBT (relative risk [RR] = 0.26; 95% confidence interval [CI] = 0.12-0.57; P = .16), but the incidence of grade III-IV acute GVHD did not differ (RR = 1.46; 95% CI = 0.42-5.03; P = .55). There was no difference in 2-year OS in children when studies were pooled (RR = 0.76; 95% CI = 0.31-1.87; P = .55). For adults, transplantation-related mortality (pooled estimate, 1.04; 95% CI = 0.52-2.08; P = .91) and disease-free survival (DFS) (pooled estimate, 0.59; 95% CI = 0.18-1.96; P = .39) were not statistically different. Because of the unavailability of randomized controlled trials, pooled analysis of nonrandomized comparative studies was performed. Thus, our meta-analysis confirmed that UCBT in children and adults had consistently equivalent survival outcomes compared with UBMT despite greater donor-recipient HLA disparity with UCBT.

Cord blood transplants supported by co-infusion of mobilized hematopoietic stem cells from a third-party donor

“…[8][9][10] In addition, several registry and single institution studies have shown, both for children and adults, overall and disease-free survival rates similar to other allogeneic HSC transplants, although with different causes of mortality. [11][12][13][14][15][16][17][18] Slow and low rate of engraftment, infections during lengthy post-transplant neutropenia and toxicity of preparative regimens were recognized as factors for early TRM of CBT in large registry-based observational studies. [13][14] Low cell content in the transplanted product and higher degree of HLA incompatibility are, in turn, the main factors for graft failure and late engraftment.…”

Umbilical cord blood banking: an update

“…Cord blood is considered a treatment option in pediatric and adult patients with hematologic malignancies and disorders (leukemia, thalassemia, sickle cell disease, etc. ), bone marrow failures, inherited metabolic disorders, immunological defects and other genetic diseases [1][2][3][4][5][6][7][8][9][10][11][12]. Double umbilical cord blood grafts, that use cord blood units from two donors, mitigate cell dose limitations for larger children and adults with malignant disorders [12][13][14].…”

Cord blood transplantation in adults

“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Recently several reviews including the clinical results of adult CBT have been published. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] In this review, we focus on recent results of myeloablative CBT in adults.…”