Cord Blood Transplants May Outperform Matched Sibling Donors

When a cancer patient needs a bone marrow transplant, there are four common donor sources: A matched related donor (sibling), a matched unrelated donor (from a donor database), a half-matched donor, or umbilical cord blood.

There are advantages and disadvantages to each approach, but consensus has generally ranked a matched sibling first, followed by a matched unrelated donor, with cord blood and half-matched donors reserved for patients without either of the first two options.

Hematologists at the University of Colorado Anschutz Medical Campus (Aurora, CO, USA) compared outcomes among adult matched related donor (MRD) patients undergoing peripheral blood stem cell transplantation and adult patients undergoing double unit cord blood transplantation (CBT), between 2010 and 2017. A total of 190 CBT patients were compared with 123 MRD patients. Median follow-up was 896 days (range, 169-3,350) among surviving CBT patients and 1,262 days (range, 249-3,327) among surviving MRD patients. For MRD donors, median infused cells were 6.07 × 106 CD34/kg (range, 2.99-9.66).

The scientists reported that in the comparison of 190 patients receiving cord-blood transplants with 123 patients receiving transplants from the "gold standard" of matched sibling donors showed no difference in survival outcomes between these two approaches, with significantly fewer complications due to chronic graft-versus-host disease in patients receiving transplants from cord blood. In addition to showing a decrease in the chance of graft-versus-host disease, which develops when a transplanted blood system attacks a patient's tissues, the study shows a slightly lower rate of relapse in these patients undergoing transplant with cord blood.

Jonathan A. Gutman, MD, CU Cancer Center investigator and director of the allogeneic stem cell transplantation program and senior author of the study, said, “It turns out that for adults, it's very hard to find a single cord blood unit that meets the parameters we know need to be met in terms of size. To overcome this barrier, we often use two units from different sources. We think there are important advantages of cord blood, especially with respect to graft-versus-host disease. Previously, we've taken a position recommending cord blood over matched unrelated donors, and now we show that cord blood may even out-compete the gold standard of matched sibling donors.” The study was published on May 22, 2020 in the journal Blood Advances.

Related Links:
University of Colorado Anschutz Medical Campus