Comparison of long-term outcomes after first HLA-mismatched unrelated donor transplantation with single unrelated cord blood transplantation using reduced-intensity or reduced-toxicity conditioning.

Transplant immunology 2024 Feb

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No comparative data have shown significant survival differences between HLA-mismatched unrelated donor (MMUD) transplantation and cord blood (CB) transplantation, each with reduced-intensity/reduced-toxicity conditioning (RIC/RTC). However, advances in graft-versus-host disease (GVHD) prophylaxis might help update current strategies. We retrospectively compared the outcomes of first allogeneic hematopoietic cell transplantation from MMUDs (n = 15) or single unrelated CB (n = 35) after RIC/RTC. The median age was 60 years. The MMUD group had a numerically lower 100-day incidence of grade III-IV acute GVHD (7% vs. 29%, P = 0.079) and non-relapse mortality (0% vs. 40%, P = 0.12). Eight MMUD recipients received anti-thymocyte globulin, bortezomib, or posttransplant cyclophosphamide for GVHD prophylaxis. They did not develop grade III-IV acute GVHD. The MMUD group had significantly better 5-year overall survival than the CB group (62% vs. 31%, P = 0.021), although relapse rates were similar. A multivariable analysis and sensitivity analysis also showed trends toward higher overall survival in the MMUD group. MMUD with better GVHD prophylaxis might be preferred over CB in patients with older age and comorbidities. Copyright © 2024 Elsevier B.V. All rights reserved.

Citation

Masatomo Kuno, Hideo Koh, Kentaro Ido, Kazuki Sakatoku, Yosuke Makuuchi, Teruhito Takakuwa, Asao Hirose, Hiroshi Okamura, Mitsutaka Nishimoto, Yasuhiro Nakashima, Mika Nakamae, Masayuki Hino, Hirohisa Nakamae. Comparison of long-term outcomes after first HLA-mismatched unrelated donor transplantation with single unrelated cord blood transplantation using reduced-intensity or reduced-toxicity conditioning. Transplant immunology. 2024 Feb;82:101988