Early Immune Reaction after Reduced-Intensity Cord-Blood Transplantation for Adult Patients

Abstract

Immune reactions after RI-CBT can be categorized into three distinct subtypes.

A novel reduced-intensity umbilical cord blood transplantation using a recombinant G-CSF combined with high-dose Ara-C for active myeloid malignancies

“…CBT performed after myeloablative or reduced-intensity preconditioning has contributed to advancing HSCT therapy for these patients and has been extensively investigated, including comparisons of conditioning regimens (Table 3). 3,14,15,26,[28][29][30][31][32][33][34][35][36][37] The reported engraftment rate is 53-93%, and the rate has been improving, possibly owing to the introduction of double-unit CBT. The reported frequency of grade II-IV acute GVHD is 20-44%; the 1-year OS ranges from 33 to 71%, and the TRM at 1 year ranges from 12 to 43%.…”

“…The risk factors for graft failure might depend on inappropriate conditioning, active disease, a small number of infused cells and unsuitable prophylaxis for GVHD. 39 Concomitant uncontrolled preengraftment immune reaction 26 and hemophagocytic syndrome 40 are frequently observed in CBT, and thus they are also important risk factors for graft failure. The median nucleated cell count of the cord blood used in our study was 2.6 × 10 7 /kg without particular selection of cord blood with a high nucleated cell count, in accordance with other researchers (Table 3).…”

Prophylactic and therapeutic treatment of graft-versus-host disease in Japan

“…They subsequently reported the merit of the use of Tac instead of CsA to suppress post-CBT immune reactions, including pre-engraftment immune reaction and acute GVHD [82,83]. After demonstrating the feasibility of RIC CBT with CsA or Tac alone for patients aged 55 years and higher [84], Uchida et al [85] added MMF to Tac as GVHD prophylaxis in RIC CBT for elderly patients.…”

Identification of molecular markers for pre-engraftment immune reactions after cord blood transplantation by SELDI-TOF MS

“…These reactions were classified as 'pre-engraftment immune reaction (PIR)' if they developed 6 or more days before engraftment, whereas those within 5 days of engraftment were defined as 'engraftment syndrome' (1). The reported incidence of PIR has ranged from 78-83% (1)(2). This PIR peaks at around day 9 of CBT, and is often accompanied by high-grade fever.…”

“…1,2 In previous reports, when patients with no evidence of infection or adverse effects of medication exhibited skin eruption, diarrhea, jaundice or body weight gain greater than 10% of baseline, these conditions were defined as 'immune reactions.' These reactions were classified as 'pre-engraftment immune reaction (PIR)' if they developed 6 or more days before engraftment, whereas those within 5 days of engraftment were defined as 'engraftment syndrome' (1). The reported incidence of PIR has ranged from 78-83% (1)(2).…”