Outcome of Cord-Blood Transplantation From Related and Unrelated Donors

Gluckman, Éliane; Rocha, Vanderson; Boyer-Chammard, Agnès; Locatelli, Franco; Arcese, William; Pasqüini, Ricardo; Ortega, Juan José López; Souillet, G; Ferreira, Eurípedes; Laporte, Jean-Philippe; Fernandez, Manual; Chastang, Claude

doi:10.1097/00006254-199801000-00011

Cited by 123 publications

(203 citation statements)

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“…UCB is enriched with haematopoietic progenitor cells and contains sufficient numbers of HSCs to reconstitute most paediatric patients. 1,2,4,6,8,9,17,19,[26][27][28][29][30][31][32][33] Most studies have shown that the nucleated cell dose is of paramount importance for haematopoietic recovery, 2,4,6,14,16,17 Wagner et al 10 have also shown the CD34 cell dose as being a significant variable not only for haematopoietic recovery but also for survival. The importance of CD34 cell dose has been replicated in other studies.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] Unrelated UCB has been used successfully for patients with a range of malignant and non-malignant diseases including leukaemia and lymphoma, constitutional and acquired BM failure syndromes, severe congenital immunodeficiency syndromes, haemoglobinopathies and selected metabolic disorders. [1][2][3][4]6,[8][9][10][11] It has been estimated that more than 95% of patients are able to find at least one potential 4 of 6 HLA matched cord blood unit on the National Marrow Donor Registry, with the majority finding a potential five of six match. 12 The known advantages of unrelated UCB over unrelated BM are well documented and include increased speed of availability, 13 absence of risk to the donor, reduced transmission of viral illnesses such as CMV, tolerance of HLA disparity between the donor and recipient, 9,14,15 better minority representation in UCB banks and reduced risk and severity of acute GVHD when compared to BM grafts.…”

Section: Introductionmentioning

confidence: 99%

“…12 The known advantages of unrelated UCB over unrelated BM are well documented and include increased speed of availability, 13 absence of risk to the donor, reduced transmission of viral illnesses such as CMV, tolerance of HLA disparity between the donor and recipient, 9,14,15 better minority representation in UCB banks and reduced risk and severity of acute GVHD when compared to BM grafts. 1,2,[4][5][6]9,10,14,16,17 When compared to BM, however, cord blood results in less optimal engraftment kinetics with higher rate of graft failure and slower haematopoietic recovery time. 10,[18][19][20][21][22] Recent reports suggest that unrelated UCB transplants now account for 20% of all allogeneic transplantations performed in young patients less than 20 years of age.…”

Section: Introductionmentioning

confidence: 99%

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Outcome following unrelated cord blood transplant in 136 patients with malignant and non-malignant diseases: a report from the Australian and New Zealand children's haematology and oncology group

Petterson

Gabriel

Tiedemann

et al. 2008

Bone Marrow Transplant

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Unrelated umbilical cord blood (UCB) is an alternative stem cell source for paediatric patients lacking a matched related or unrelated marrow donor. We report the results of all paediatric unrelated UCB transplants performed in Australia and New Zealand over a 10-year period. A total of 135 patients were transplanted, 100 for malignant disease (74%) and 35 for non-malignant disorders. The majority (88%) of patients received an HLA-mismatched graft. The median infused total nucleated cell dose was 4.7 Â 10 7 /kg and CD34 þ count 1.9 Â 10 5 /kg. Neutrophil engraftment occurred in 83% of patients by day 42 (median 23 days) and platelet engraftment in 55% by day 60 (median 56 days). Grades II-IV and III-IV acute GVHD occurred in 41 and 18% of patients, respectively. TRM and overall survival 1-year post transplant were 32 and 61%, respectively. A higher probability of neutrophil recovery (P ¼ 0.004) and faster time to recovery (median 18 days vs 26 days, P ¼ 0.008) were observed in recipients of a cord unit with a CD34 cell dose X1.7 Â 10 5 /kg. Our results support selection of cord units with CD34 cell doses X1.7 Â 10 5 /kg to promote faster engraftment, improve survival and lower TRM.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Outcome following unrelated cord blood transplant in 136 patients with malignant and non-malignant diseases: a report from the Australian and New Zealand children's haematology and oncology group

Petterson

Gabriel

Tiedemann

et al. 2008

Bone Marrow Transplant

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“…[2][3][4][5][6][7] The frequency of infectious complications is closely related to the number of donor-derived T cells and their immunological reconstitution after transplantation. Therefore, it is important to explore the T cell number and reconstitution pattern in the case of umbilical cord blood transplantation.…”

mentioning

confidence: 99%

Immunological reconstitution after cord blood transplantation for an adult patient

Nagayama

Nakayama

Yasuo

et al. 1999

Bone Marrow Transplant

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Summary:We transplanted 4.1 ؋ 10 7 unrelated umbilical cord blood cells into a 27-year-old patient suffering from transformed acute myelocytic leukemia. The thawing method was the same as described by Rubinstein et al (Proc Natl Acad Sci USA 1995; 92: 10119-10122). ANC reached over 500 ؋ 10 9 /l on day 19, and the patient was free from RBC and platelet transfusion on days 26 and 38, respectively. Cytogenetic and molecular analysis after transplant revealed complete chimerism. The CD3 + CD4 + lymphocyte count became greater than 100 ؋ 10 9 /l at 5 weeks after transplantation. The CD3 + CD8 + count became greater than 500 ؋ 10 9 /l at 7 weeks and thereafter progressively increased in spite of administration of CYA. This immunological reconstitution pattern after umbilical cord blood transplantation was different from that after bone marrow transplantation, and resistance of CD3 + CD8 + lymphocytes to CYA was the distinguishing characteristic. The rapid hematological recovery and immunological reconstitution may be attributed to the high dose of transfused nucleated cells and umbilical cord blood transplantation may become a promising method for treatment for such cases.

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Flow cytometric enumeration of CD34+ hematopoietic stem and progenitor cells

et al. 1998

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The need for a rapid and reliable marker for the engraftment potential of hematopoietic stem and progenitor cell (HPC) transplants has led to the development of flow cytometric assays to quantitate such cells on the basis of their expression of CD34. The variability associated with enumeration of low‐frequency cells (i.e., as low as 0.1% or 5 cells/μl) is exceedingly large, but recent developments have improved the accuracy and precision of the assay. Here, we review and compare the major techniques. Based on the current state of the art, we recommend 1) bright fluorochrome conjugates of class II or III monoclonal antibodies (mAbs) that detect all glycoforms of CD34, 2) use of a vital nucleic acid dye to exclude platelets, unlysed red cells, and debris or use of 7‐amino actinomycin D to exclude dead cells during data acquisition, 3) counterstaining with CD45 mAb to be included in the definition of HPC, 4) during list mode data analysis, Boolean gating to resolve the CD34+ HPCs from irrelevant cell populations on the basis of the low levels of CD45 expression and low sideward light‐scatter signals of HPCs, 5) inclusion of CD34dim and CD34bright populations in the CD34+ cell count, 6) omission of the negative control staining, and 7) for apheresis products, enumeration of at least 100 CD34+ cells to ensure a 10% precision. Unresolved technical questions are 1) the replacement of conventional dual‐platform by single‐platform assay formats, i.e., derivation of absolute CD34+ cell counts from a single flow cytometric assessment instead of from combined flow cytometer (percent CD34+) and hematology analyzer (absolute leukocyte count) data, 2) the cross‐calibration of the available single‐platform assays, and 3) the optimal method for sample preparation. An important clinical question to be addressed is the definition of the precise phenotypes and required numbers of HPCs responsible for short‐ and long‐term recovery to optimize HPC transplant strategies. Cytometry (Comm. Clin. Cytometry) 34: 128–142, 1998. © 1998 Wiley‐Liss, Inc.

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Outcome of Cord-Blood Transplantation From Related and Unrelated Donors

Cited by 123 publications

References 0 publications

Outcome following unrelated cord blood transplant in 136 patients with malignant and non-malignant diseases: a report from the Australian and New Zealand children's haematology and oncology group

Outcome following unrelated cord blood transplant in 136 patients with malignant and non-malignant diseases: a report from the Australian and New Zealand children's haematology and oncology group

Immunological reconstitution after cord blood transplantation for an adult patient

Flow cytometric enumeration of CD34+ hematopoietic stem and progenitor cells

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