Comparison of Unrelated Cord Blood and Peripheral Blood Stem Cell Transplantation in Adults with XXXX after Reduced-Intensity Conditioning Regimen: A Collaborative Study from Eurocord (Cord blood Committee of Cellular Therapy _ Immunobiology Working Party of EBMT) and Chronic Malignancies Working Party.

@entity1 @entity2132 @entity2590 @entity1349
UNASSIGNED: Hematopoietic stem cell transplantation (HSCT) remains the only curative treatment in @entity1 with higher risk @entity2590 ( @entity2590 ), but the choice of the optimal alternative stem cell source is still a subject of debate in @entity1 lacking an HLA-matched sibling donor. Here, we report on a large series of @entity1 with @entity2590 (N  =  631) transplanted either with mobilized peripheral stem cells (PBs) from unrelated donors (n  =  502) or with umbilical cord blood transplant (UCB, n  =  129) as alternative grafts after reduced-intensity conditioning. Neutrophil engraftment was higher after PB (98% versus 78%, P  <  .0001). @entity2132 ( @entity2132 ) was similar after PB (31%) and UCB (29%), and chronic @entity2132 incidence was higher after PB (41% versus 23%). Two-year nonrelapse mortality was lower after PB (31% versus 42% P  =  .03). There was a better @entity1349 ( @entity1349 ) and disease-free survival (DFS) after PB (49%      2% versus 30%      4%, P  <  .0001 and 44%      2% versus 28%      4%, P  <  .0001). Multivariate analysis confirmed the advantage of PB for treatment-related mortality, @entity1349 , and DFS, whereas relative risk of chronic @entity2132 was similar. A multivariate analysis comparing PB from a 10/10 HLA-matched donor, PB from a 9/10 HLA-matched donor, and UCB showed an advantage on treatment-related mortality, DFS, and @entity1349 only in 10/10  PB. We conclude that in @entity2590 @entity1 lacking an HLA-matched sibling donor, PB from a 10/10 HLA-matched unrelated donor is the preferred source of hematopoietic stem cells. HLA-mismatched unrelated donor or cord blood seem to give similar inferior results except for neutrophil engraftment, which is delayed after UCB.
