Cord Blood Transplantation from Unrelated Donors in Adults with High-Risk Acute Myeloid Leukemia

Sanz, Jaime; Sanz, Miguel Á.; Saavedra, Silvana; Lorenzo, Ignacio; Montesinos, Pau; Senent, Leonor; Planelles, Dolores; Larrea, Luís; Martı́n, Guillermo; Palau, Javier; Jarque, Isidro; Martı́nez, Jesús; Rubia, Javier de la; Moscardó, Federico; Romero, M.; Luna, Irene; Montava, Alberto; Cañabate, Sergio; Sanz, Guillermo

doi:10.1016/j.bbmt.2009.09.001

Cited by 74 publications

(70 citation statements)

References 33 publications

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“…The treatment plans including graft selection, conditioning regimen, immune suppression and supportive care have been reported in detail previously, [4][5][6] and are summarized below.…”

Section: Patients and Methods Patientsmentioning

confidence: 99%

Autoimmune cytopenias after umbilical cord blood transplantation in adults with hematological malignancies: a single-center experience

Sanz

Arango

Carpio

et al. 2014

Bone Marrow Transplant

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We describe incidence, clinical features, serological data, response to therapy and outcome of autoimmune cytopenias (ACs), including autoimmune hemolytic anemia (AIHA) and autoimmune thrombocytopenia (AIT) in a series of 281 consecutive adults with hematological malignancies that received single-unit umbilical cord blood transplantation (UCBT) at a single institution. AIHA was diagnosed in 15 patients at a median time of 181 days (range, 25-543), 12 of them had cold antibodies (IgM). The 3-year cumulative incidence (CI) of AIHA was 5.4% (CI 95% 2.7-8.1). Concomitant infections at the time of AIHA were present in 10 patients. Five out of nine patients that received corticosteroids achieved either a PR or a CR, whereas six out of eight patients that received rituximab responded. Four patients developed AIT giving a 3-year CI of 1.4% (CI 95% 0-2.8), concomitant infections were present in three of them. Multivariable analysis showed that development of chronic GVHD (relative risk (RR) 4; 95% CI 1.1-13.7; P = 0.03) and diagnosis of CML (RR 4.3; 95% CI 1.5-12.7; P = 0.008) were associated with an increased risk of AC. In conclusion, AIHA and AIT are relevant and clinically significant complications in UCBT recipients, especially among those that develop chronic GVHD. Response to therapy is sub-optimal, and rituximab should be considered as a therapeutic option, in this setting were most patients had cold AIHA and a serological profile similar to that seen in cold agglutinin disease.

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“…The treatment plans including graft selection, conditioning regimen, immune suppression and supportive care have been reported in detail previously, [4][5][6] and are summarized below.…”

Section: Patients and Methods Patientsmentioning

confidence: 99%

Autoimmune cytopenias after umbilical cord blood transplantation in adults with hematological malignancies: a single-center experience

Sanz

Arango

Carpio

et al. 2014

Bone Marrow Transplant

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“…The institutional review board approved the protocol and written informed consent was obtained from all patients according to the Declaration of Helsinki. The treatment plans including graft selection, conditioning regimen, immune suppression and supportive care have been reported in detail previously, [4][5][6] and are summarized below.…”

Section: Eligibility Criteriamentioning

confidence: 99%

EBV-associated post-transplant lymphoproliferative disorder after umbilical cord blood transplantation in adults with hematological diseases

Sanz

Arango

Senent

et al. 2013

Bone Marrow Transplant

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We analyzed the incidence, clinicopathological features, risk factors and prognosis of patients with EBV-associated post-transplant lymphoproliferative disorder (EBV-PTLD) in 288 adults undergoing umbilical cord blood transplantation (UCBT) at a single institution. Twelve patients developed proven EBV-PTLD at a median time of 73 days (range, 36-812). Three-year cumulative incidence (CI) of EBV-PTLD was 4.3% (95% CI: 1.9-6.7). All patients presented with extranodal involvement. Most frequently affected sites were the liver, spleen, central nervous system (CNS), Waldeyer's ring and BM in 7, 6, 4, 3 and 3 patients, respectively. One patient had polymorphic and 11 had monomorphic EBV-PTLD (7 diffuse large B-cell lymphomas not otherwise specified, 4 plasmablastic lymphomas). We confirmed donor origin and EBV infection in all histological samples. EBV-PTLD was the cause of death in 11 patients at a median time of 23 days (range, 1-84). The 3-year CI of EBV-PTLD was 12.9% (95% CI: 3.2-22.5) and 2.6% (95% CI: 0.5-4.7) for patients receiving reduced-intensity conditioning (RIC) and myeloablative conditioning, respectively (Po0.0001). In conclusion, adults with EBV-PTLD after UCBT showed frequent visceral and CNS involvement. The prognosis was poor despite routine viral monitoring and early intervention. An increased risk of EBV-PTLD was noted among recipients of RIC regimens.

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“…22,23 Again the CD34 + cell content at the time of freezing the unit was the major determinant of engraftment.…”

Section: Discussionmentioning

confidence: 99%

“…22,23 Again the CD34 + cell content at the time of freezing the unit was the major determinant of engraftment. 22,24 Therefore, although there is discussion about the reliability of CD34 + measurements across different laboratories, CD34 + cell counts should be taken into account in graft selection.…”

Section: Discussionmentioning

confidence: 99%

Umbilical cord blood transplantation from unrelated donors in patients with Philadelphia chromosome-positive acute lymphoblastic leukemia

et al. 2013

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© F e r r a t a S t o r t i F o u n d a t i o n an unrelated donor within the Grupo Español de Trasplante Hematopoyético (GETH) and the Rome Transplant Network of the Gruppo Italiano Trapianto Midollo Osseo (GITMO). Most of the patients were included in two subsequent prospective trials: TSCU-GETH2005 and TSCU-GETH/GITMO2008 (registered with EudraCT with code 2008-000927-24). The institutional review board approved the protocol and written informed consent was obtained from all patients according to the Declaration of Helsinki. Selection of cord blood units and transplant characteristicsUmbilical cord blood units were required to be HLA-matched with the recipient at ≥ 4/6 loci. Until 2005 the cord blood units were required to contain a total nucleated cell dose ≥1.5x10 Graft-versus-host disease (GvHD) prophylaxis was based on cyclosporine combined with either long-course prednisone or mycophenolate mofetil. Disease evaluation and tyroskine kinase inhibitorsPre-transplant disease status was assessed during the 30 days prior to UCBT. Minimal residual disease was assessed by qualitative or quantitative polymerase chain reaction (PCR) analysis of p190 BCR/ABL mRNA. The PCR was performed in each participating center using TaqMan technology in accordance with the guidelines approved in the Europe Against Cancer Program. 12A TKI was given after engraftment at the physicians' discretion. The generally accepted practice before starting TKI therapy included an evaluation of hematopoietic engraftment, ability of oral intake, and the potential risks of drug interactions. DefinitionsComplete remission was defined according to standard morphological criteria as outlined by the International Working Group. 13 A negative molecular status was defined as <1x10 -4 BCR-ABL transcript copies, assessed by qualitative or quantitative PCR. Graft failure was defined as the failure to achieve myeloid engraftment in patients alive at day +28 after transplantation. Secondary graft failure was defined as the loss of previously achieved engraftment. Acute and chronic GvHD were diagnosed on the basis of previously published criteria.14,15 For event-free survival, hematologic relapse, death and graft failure were considered as treatment failure. Statistical analysisThe primary endpoint of this study was long-term event-free survival after UCBT. Secondary endpoints were engraftment, regimen-related toxicity, overall survival, relapse rate, and nonrelapse mortality. Engraftment, non-relapse mortality, GvHD, and relapse were estimated by the cumulative incidence method. 16Unadjusted time-to-event analyses were performed using the Kaplan-Meier estimate, 17 and, for comparisons, log-rank tests. 18Statistical analyses were conducted using R version 2.12.2 (the CRAN project) with packages, survival v2.36-10, Design 2.3-0, prodlim v1.2.1 and cmprsk v2.2-2. 19 Results Patients and disease characteristicsOverall, 45 consecutive patients with Ph + ALL underwent myeloablative UCBT. The patients' main characteristics are summarized in Table 1. Th...

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Cord Blood Transplantation from Unrelated Donors in Adults with High-Risk Acute Myeloid Leukemia

Cited by 74 publications

References 33 publications

Autoimmune cytopenias after umbilical cord blood transplantation in adults with hematological malignancies: a single-center experience

Autoimmune cytopenias after umbilical cord blood transplantation in adults with hematological malignancies: a single-center experience

EBV-associated post-transplant lymphoproliferative disorder after umbilical cord blood transplantation in adults with hematological diseases

Umbilical cord blood transplantation from unrelated donors in patients with Philadelphia chromosome-positive acute lymphoblastic leukemia

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