Background: 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.
Methods: We retrospectively compared the outcomes of first allogeneic hematopoietic cell transplantation from MMUDs (n = 15) or single unrelated CB (n = 35) after RIC/RTC.
Results: 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.
Conclusion: MMUD with better GVHD prophylaxis might be preferred over CB in patients with older age and comorbidities.
Competing Interests: Declaration of competing interest HK reports receiving an honorarium from Novartis. TT reports receiving research funding from Pfizer and honoraria from Chugai, Janssen, Novartis, and Sanofi. MNi reports receiving research funding from Janssen and Pfizer and honoraria from Janssen and Otsuka. YN reports receiving research funding from Chugai and Novartis and honoraria from Chugai, Janssen, and Novartis. MH reports receiving scholarship grants from Chugai and Otsuka and honoraria from Chugai, Janssen, Novartis, Otsuka, Pfizer, and Sanofi. HN reports receiving research funding from Novartis and honoraria from Janssen, Novartis, and Otsuka. This report was not funded by any of these companies. The other authors declare no conflicts of interest associated with this manuscript.
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