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Role and cost efficacy of unrelated cord blood in adult hematopoietic stem transplantation

Bone Marrow Transplantation volume 36, page 275 (2005)Cite this article

The Eurocord / European Blood and Marrow Transplant Group and International Bone Marrow Transplant Registry / National Cord Blood Program recently reported a retrospective analysis of the outcome of unrelated cord blood and bone marrow transplantation in adult patients.1, 2 The authors concluded that cord blood is an alternative to bone marrow as an unrelated source of hematopoietic stem cells. This statement deserves some consideration because several questions still remain unresolved. The major potential advantage of cord blood, that is, the prompt availability of the selected unit in 3–4 weeks,3 has been not prospectively investigated to date and its impact on transplant outcome is not clear. Ideally, faster identification of a suitable cord blood unit should result in a more timely transplant avoiding any further delay that could expose the patient to the risk of losing the eligibility for transplant due to relapse or other complications. In Rocha's report, the patients in first complete remission underwent stem cell transplantation after a median interval of 18 months from diagnosis, irrespective of whether the stem cell source was cord blood or bone marrow; the patients in second complete remission who received cord blood stem cells were transplanted earlier than patients who received bone marrow stem cells, the median time from relapse to transplant being 51 and 59 months, respectively, but this was not associated with a better leukemia-free survival.1 Moreover, the retrospective design of the study may have biased the results because allocation of patients could reflect the different attitude of transplant centers to the use of cord blood and bone marrow instead of timely donor search steps. The fact that the leukemia-free-survival rates for cord blood are lower than those for matched unrelated bone marrow recipients2 and superimposable on those reported, although with smaller numbers, for haploidentical transplants, raises the question of which source of stem cells should be considered as the alternative to bone marrow if a matched unrelated donor is not available.3, 4 Certainly, haploidentical transplant is competitive both for costs and for the timing of donor availability. Moreover, the costs of cord blood transplant may be augmented in the future by the use of two cord blood grafts.5, 6

In conclusion, cord blood stem cells represent a valuable option for patients lacking a matched related or unrelated donor, but a prospective comparison of alternative sources, including cord blood and haploidentical donors, may help define the best time to transplant and the cost-efficacy ratio of different stem cell sources: bone marrow, cord blood and peripheral blood.

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References

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  1. Department of Pediatrics, Clinic of Pediatric Hematology Oncology, University of Padova, Padova, Italy

    S Cesaro

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Cesaro, S. Role and cost efficacy of unrelated cord blood in adult hematopoietic stem transplantation. Bone Marrow Transplant 36, 275 (2005). https://doi.org/10.1038/sj.bmt.1705058

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