A Comparison of Outcomes for Cord Blood Transplantation and Unrelated Bone Marrow Transplantation in Adult Aplastic Anemia

Japan Society for Hematopoietic Cell Transplantation

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Earlier reports suggested that umbilical cord blood transplantation (UCBT) for aplastic anemia (AA) was feasible in alternative transplantation. To identify differences in outcomes of UCBT and HLA-matched or mismatched unrelated bone marrow transplantation (UBMT) in adults with AA, we analyzed registry data of the Japan Society for Hematopoietic Cell Transplantation and compared results of UCBT (n = 69) to 8/8-matched (n = 101), 7/8-matched (n = 65), or 6/8-matched (n = 37) UBMT. The transplantation period was from 2002 to 2012, and patients 16 years or older with AA were eligible. Median ages were 49, 35, 28, and 30 years for UCBT, 8/8-matched, 7/8-matched, and 6/8-matched UBMT, respectively. In multivariate analysis, risk of mortality was lower for 8/8-matched UBMT compared with that of UCBT (hazard ratio [HR], 55; 95% confidence interval [CI], 32 to .94; P = .029), adjusted for age and graft-versus-host disease (GVHD) prophylaxis, which were other associated factors. Mortality risks of 7/8-matched UBMT (HR, 55; 95% CI, 29 to 1.02) or 6/8-matched UBMT (HR, 67; 95% CI, 32 to 1.39) were not significantly different from those of UCBT. Risks of grade 3 or 4 acute and chronic GVHD were not different among the 4 groups. The most prevalent cause of death was graft failure in UCBT and 6/8-matched UBMT and infection in 8/8-matched and 7/8-matched UBMT. Under 40 years old,survival of UCBT was similar to that of UBMT (76%, 79%, 83%, and 83% for UCBT and 8/8-matched, 7/8-matched, and 6/8-matched UBMT, respectively, at 3 years), adjusted for transplantation period, which was another associated factor; however, for ages over 40 years, that of UCBT tended to be lower (47%, 64%, 64%, and 75% for UCBT, 8/8-matched, 7/8-matched, and 6/8-matched UBMT, respectively, at 3 years). To conclude, these data suggest that UCBT could be an alternative treatment option for younger adults when matched sibling or adequate UBMT donors are not available.

Original languageEnglish
Pages (from-to)1836-1843
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume22
Issue number10
DOIs
Publication statusPublished - 2016 Oct 1

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Aplastic Anemia
Bone Marrow Transplantation
Fetal Blood
Transplantation
Graft vs Host Disease
Confidence Intervals
Mortality
Cell Transplantation
Registries

Keywords

  • Aplastic anemia
  • Cord blood transplantation
  • Unrelated bone marrow transplantation

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

A Comparison of Outcomes for Cord Blood Transplantation and Unrelated Bone Marrow Transplantation in Adult Aplastic Anemia. / Japan Society for Hematopoietic Cell Transplantation.

In: Biology of Blood and Marrow Transplantation, Vol. 22, No. 10, 01.10.2016, p. 1836-1843.

Research output: Contribution to journalArticle

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title = "A Comparison of Outcomes for Cord Blood Transplantation and Unrelated Bone Marrow Transplantation in Adult Aplastic Anemia",
abstract = "Earlier reports suggested that umbilical cord blood transplantation (UCBT) for aplastic anemia (AA) was feasible in alternative transplantation. To identify differences in outcomes of UCBT and HLA-matched or mismatched unrelated bone marrow transplantation (UBMT) in adults with AA, we analyzed registry data of the Japan Society for Hematopoietic Cell Transplantation and compared results of UCBT (n = 69) to 8/8-matched (n = 101), 7/8-matched (n = 65), or 6/8-matched (n = 37) UBMT. The transplantation period was from 2002 to 2012, and patients 16 years or older with AA were eligible. Median ages were 49, 35, 28, and 30 years for UCBT, 8/8-matched, 7/8-matched, and 6/8-matched UBMT, respectively. In multivariate analysis, risk of mortality was lower for 8/8-matched UBMT compared with that of UCBT (hazard ratio [HR], 55; 95{\%} confidence interval [CI], 32 to .94; P = .029), adjusted for age and graft-versus-host disease (GVHD) prophylaxis, which were other associated factors. Mortality risks of 7/8-matched UBMT (HR, 55; 95{\%} CI, 29 to 1.02) or 6/8-matched UBMT (HR, 67; 95{\%} CI, 32 to 1.39) were not significantly different from those of UCBT. Risks of grade 3 or 4 acute and chronic GVHD were not different among the 4 groups. The most prevalent cause of death was graft failure in UCBT and 6/8-matched UBMT and infection in 8/8-matched and 7/8-matched UBMT. Under 40 years old,survival of UCBT was similar to that of UBMT (76{\%}, 79{\%}, 83{\%}, and 83{\%} for UCBT and 8/8-matched, 7/8-matched, and 6/8-matched UBMT, respectively, at 3 years), adjusted for transplantation period, which was another associated factor; however, for ages over 40 years, that of UCBT tended to be lower (47{\%}, 64{\%}, 64{\%}, and 75{\%} for UCBT, 8/8-matched, 7/8-matched, and 6/8-matched UBMT, respectively, at 3 years). To conclude, these data suggest that UCBT could be an alternative treatment option for younger adults when matched sibling or adequate UBMT donors are not available.",
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author = "{Japan Society for Hematopoietic Cell Transplantation} and Yachiyo Kuwatsuka and Junya Kanda and Hirohito Yamazaki and Takehiko Mori and Koichi Miyamura and Shinichi Kako and Naoyuki Uchida and Kazuteru Ohashi and Yukiyasu Ozawa and Yoshiyuki Takahashi and Chiaki Kato and Koji Iwato and Ken Ishiyama and Hikaru Kobayashi and Tetsuya Eto and Kaoru Kahata and Jun Kato and Toshihiro Miyamoto and Koji Kato and Shinicihro Mori and Yoshiko Atsuta and Fumihiko Kimura and Yoshinobu Kanda",
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AU - Japan Society for Hematopoietic Cell Transplantation

AU - Kuwatsuka, Yachiyo

AU - Kanda, Junya

AU - Yamazaki, Hirohito

AU - Mori, Takehiko

AU - Miyamura, Koichi

AU - Kako, Shinichi

AU - Uchida, Naoyuki

AU - Ohashi, Kazuteru

AU - Ozawa, Yukiyasu

AU - Takahashi, Yoshiyuki

AU - Kato, Chiaki

AU - Iwato, Koji

AU - Ishiyama, Ken

AU - Kobayashi, Hikaru

AU - Eto, Tetsuya

AU - Kahata, Kaoru

AU - Kato, Jun

AU - Miyamoto, Toshihiro

AU - Kato, Koji

AU - Mori, Shinicihro

AU - Atsuta, Yoshiko

AU - Kimura, Fumihiko

AU - Kanda, Yoshinobu

PY - 2016/10/1

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N2 - Earlier reports suggested that umbilical cord blood transplantation (UCBT) for aplastic anemia (AA) was feasible in alternative transplantation. To identify differences in outcomes of UCBT and HLA-matched or mismatched unrelated bone marrow transplantation (UBMT) in adults with AA, we analyzed registry data of the Japan Society for Hematopoietic Cell Transplantation and compared results of UCBT (n = 69) to 8/8-matched (n = 101), 7/8-matched (n = 65), or 6/8-matched (n = 37) UBMT. The transplantation period was from 2002 to 2012, and patients 16 years or older with AA were eligible. Median ages were 49, 35, 28, and 30 years for UCBT, 8/8-matched, 7/8-matched, and 6/8-matched UBMT, respectively. In multivariate analysis, risk of mortality was lower for 8/8-matched UBMT compared with that of UCBT (hazard ratio [HR], 55; 95% confidence interval [CI], 32 to .94; P = .029), adjusted for age and graft-versus-host disease (GVHD) prophylaxis, which were other associated factors. Mortality risks of 7/8-matched UBMT (HR, 55; 95% CI, 29 to 1.02) or 6/8-matched UBMT (HR, 67; 95% CI, 32 to 1.39) were not significantly different from those of UCBT. Risks of grade 3 or 4 acute and chronic GVHD were not different among the 4 groups. The most prevalent cause of death was graft failure in UCBT and 6/8-matched UBMT and infection in 8/8-matched and 7/8-matched UBMT. Under 40 years old,survival of UCBT was similar to that of UBMT (76%, 79%, 83%, and 83% for UCBT and 8/8-matched, 7/8-matched, and 6/8-matched UBMT, respectively, at 3 years), adjusted for transplantation period, which was another associated factor; however, for ages over 40 years, that of UCBT tended to be lower (47%, 64%, 64%, and 75% for UCBT, 8/8-matched, 7/8-matched, and 6/8-matched UBMT, respectively, at 3 years). To conclude, these data suggest that UCBT could be an alternative treatment option for younger adults when matched sibling or adequate UBMT donors are not available.

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KW - Aplastic anemia

KW - Cord blood transplantation

KW - Unrelated bone marrow transplantation

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