Comparison of Cord Blood Transplantation with Unrelated Bone Marrow Transplantation in Patients Older than Fifty Years

• Adjusted overall survival was higher in 8/8 HLA–matched unrelated bone marrow transplantation than in umbilical cord blood transplantation in elderly patients.
• Adjusted overall survival of umbilical cord blood transplantation was similar to 7/8 HLA–matched unrelated bone marrow transplantation.
• Adjusted overall survival of umbilical cord blood transplantation with high CD34+ cells was similar to 8/8 HLA–matched unrelated bone marrow transplantation.

We retrospectively compared the transplantation outcomes for patients 50 years or older who received umbilical cord blood transplantation (UCBT) with those who received unrelated bone marrow transplantation (UBMT) for hematologic malignancies. A total of 1377 patients who underwent transplantation between 2000 and 2009 were included: 516 received 8/8 HLA allele-matched UBMT, 295 received 7/8 HLA allele-matched UBMT, and 566 received 4/6 to 6/6 HLA-matched UCBT. Adjusted overall survival (OS) was significantly lower in those who underwent UCBT than those who underwent 8/8 HLA–matched UBMT but was similar to that of 7/8 HLA–matched UBMT (the 2-year OS after 8/8 HLA–matched UBMT, 7/8 HLA–matched UBMT, and UCBT were 49% [95% confidence interval (CI), 45% to 55%], 38% [95% CI, 32% to 45%], and 39% [95% CI, 34% to 43%], respectively). However, adjusted OS was similar between 8/8 HLA–matched UBMT and UCBT receiving ≥.84 × 105 CD34+ cells/kg among those with acute myeloid leukemia and those with acute lymphoblastic leukemia (the 2-year OS was 49% [95% CI, 43% to 55%], and 49% [95% CI, 41% to 58%], respectively). These data suggest that UCB is a reasonable alternative donor/stem cell source for elderly patients with similar outcomes compared with UBM from 8/8 HLA–matched unrelated donors when the graft containing ≥.84 × 105 CD34+ cells/kg is available.