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Cord Blood Enables Stem Cell Transplant in Older Patients Without Matched Related Donors: Presented at ASH By John Gever ATLANTA, GA -- December 12, 2007 -- Older patients in need of a stem cell transplant (SCT) who do not have matched related donors available can have successful transplants with unmatched umbilical cord blood stem cells, a clinical study has confirmed. The study was presented here on December 10 in an oral session at the 49th American Society of Hematology (ASH) Annual Meeting and Exposition by Navneet S. Majhail, MD, Assistant Professor of Medicine, University of Minnesota, Minneapolis, Minnesota. In the retrospective analysis of 90 patients (age >55), rates of 3-year progression-free survival and overall survival with unmatched cord blood cells were 30% and 34%, respectively. These were similar to the rates of 43% and 34% seen with matched related donors. The differences were not significant. Of the 90 patients in the study, 47 received matched related donor cells and 43 received unmatched cord blood cells. Half the patients had acute myeloid leukemia or myelodysplastic syndrome. Treatment-related mortality was also similar with unmatched cord blood (28%) and matched related donors (23%). Cord blood is a viable option for older patients, Dr. Majhail said. "It is safe and effective." Previous studies demonstrated that unmatched cord blood SCT is safe and effective in younger patients. Multivariate analysis identified one predictor of poor outcome in the study: a high number of comorbidities. "For older patients, when they are considered for transplantation, their comorbidities should be carefully reviewed," Dr. Majhail said. A reduced-intensity conditioning regimen based on cyclophosphamide, fludarabine, and 200 cGy total body irradiation was used in most study patients, but the specific regimen did not appear to affect SCT success. Dr. Majhail noted that older patients are typically not considered to be good candidates for transplantation if no matched related donor is available, because the risk of complications is thought to be too high. Matched related donors are available for only about one third of SCT candidates, he said. The main limiting factor for unmatched cord blood SCT now is that single cords often do not contain enough stem cells to support an adult transplant. Studies are now underway to determine the safety and effectiveness of multiple-cord transplants in adult patients, Dr. Majhail said. Cord blood SCT for adults remains investigational in the United States. [Presentation title: Reduced Intensity Allogeneic Transplant in Patients Older Than 55 Years: Unrelated Umbilical Cord Blood Is Safe and Effective for Patients Without a Matched Related Donor. Abstract 331] E-mail this page to a friend or colleague! To print, use this version