For people with pretransplantation minimal residual disease, overall survival was significantly higher in those receiving a transplant from a cord-blood donor, vs those who received one from an HLA-mismatched unrelated donor, according to a retrospective analysis involving 582 individuals. Relapse was also lower in those who received cord blood.

Participants had either acute leukemia or the myelodysplastic syndrome. They received a first myeloablative hematopoietic-cell transplant from an unrelated cord-blood donor (n=140), an HLA-matched unrelated donor (n=344), or an HLA-mismatched unrelated donor (n=98).

Death and relapse risk between the cord-blood group and the other groups seemed to vary based on the presence of minimal residual disease status pre-transplant.

In those with minimal residual disease:

• Death risk was nearly 3-fold higher in the HLA-mismatched group than in the cord-blood group.

• The risk was also higher the HLA-matched group, but not significantly so.

• Relapse risk was 3-fold higher and nearly 3-fold higher in the mismatched and matched groups, respectively.

Citation: Milano F, Gooley T, Wood B, et al. Cord-blood transplantation in patients with minimal residual disease. [Published online ahead of print September 8, 2016]. N Engl J Med. doi:10.1056/NEJMoa1602074.