Utilization Patterns of Haploidentical vs Umbilical Cord Blood Grafts Post-CTN-1101

Overview

This registry analysis of 11,190 adult hematopoietic cell transplant recipients demonstrates a significant shift in graft utilization favoring haploidentical bone marrow and peripheral blood stem cell transplants over umbilical cord blood following the CTN-1101 trial publication. Demographic factors such as age, sex, and race/ethnicity influenced graft choice, with haploidentical grafts increasingly preferred across all groups.

Background

Allogeneic hematopoietic cell transplantation (HCT) is a curative option for hematologic malignancies and other blood disorders. When matched related or unrelated donors are unavailable, umbilical cord blood (UCB) and haploidentical grafts serve as alternative sources. The CTN-1101 phase 3 trial compared double unrelated UCB to haploidentical bone marrow (haplo-BM) transplantation, showing superior two-year overall survival with haplo-BM. Despite these findings, the real-world impact on graft utilization patterns had not been formally assessed until this registry analysis.

Data Highlights

Key Findings

• Haploidentical graft utilization increased significantly over time, while umbilical cord blood graft use declined following CTN-1101 publication.
• Haplo-BM and haplo-PBSC grafts showed superior long-term survival compared to double UCB grafts.
• Demographic factors influenced graft choice: younger patients, males, and non-Hispanic White patients were more likely to receive haplo grafts.
• Multivariable logistic regression confirmed transplant year and patient demographics as significant predictors of haplo versus UCB graft receipt.
• Expanded analysis including matched related and unrelated donors showed overall increased access to transplantation with diverse graft sources.

Clinical Implications

These findings support the preferential use of haploidentical grafts over umbilical cord blood in adult patients lacking matched donors, reflecting improved survival outcomes and evolving clinical practice. Awareness of demographic influences on graft selection can guide equitable transplant access and personalized donor source decisions.

Conclusion

The CTN-1101 trial findings have translated into real-world practice, with increased haploidentical graft utilization and decreased UCB use in adult hematopoietic cell transplantation. This shift aligns with improved survival outcomes and expanded transplant access.

References

1. Blood and Marrow Transplant Clinical Trials Network (CTN) 1101 Trial -- Comparison of Haploidentical Bone Marrow and Double Umbilical Cord Blood Transplantation
2. Center for International Blood and Marrow Transplant Research (CIBMTR) -- Transplant Trends 2009-2019