Cord blood versus bone marrow/peripheral blood stem cell transplantation under reduced-intensity conditioning in high-risk acute myeloid leukemia and myelodysplastic syndromes

Cord blood transplantation (CBT) is an alternative donor option for patients lacking suitable matched donors, particularly in high-risk acute myeloid leukemia (AML) or myelodysplastic syndromes (MDS). We retrospectively analyzed 76 adults undergoing reduced-intensity conditioning allogeneic transplantation using one of five donor types: CBT with ultra-low-dose methotrexate (uldMTX; <i>n</i> = 47), matched related donor (MRD), matched unrelated donor (MUD), mismatched unrelated donor (MMUD), or mismatched related donor (MMRD) (<i>n</i> = 29 across the four donor types). Two-year overall survival (OS) with uldMTX-CBT (58.8%) was significantly superior to MRD, MUD, and MMRD transplantation, with similar patterns for disease-free survival (DFS). In multivariate analyses, CBT remained independently associated with improved OS and DFS. Neutrophil and platelet recovery were comparable across donor types, as were the incidences of graft-versus-host disease and non-relapse mortality. These findings indicate that CBT provides a safe and effective donor platform with competitive outcomes across diverse alternative donor settings in high-risk AML/MDS.