Single-unit umbilical cord blood transplantation from unrelated donors in patients with hematological malignancy using busulfan, thiotepa, fludarabine and ATG as myeloablative conditioning regimen

This study aimed to assess the impact of antithymocyte globulin (ATG) on patient outcome in a retrospective series of 91 patients (median age: 12 years) who underwent unrelated single-unit cord blood transplantation (allo-CBT) following a myeloablative conditioning regimen. Cord blood units were HLA-matched (6/6, n = 18; 21%), one-Ag mismatched (n = 30, 35%) or two-Ag mismatched (n = 38; 44%). In this series, the OS, nonrelapse mortality (NRM) and cumulative incidence of relapse were 47 ± 6%, 23 ± 4% and 48 ± 5%, respectively. Among 46 patients who received ATG as part of the conditioning regimen, the incidence of acute and chronic GVHD was lower than that in the group of 45 patients who did not receive ATG (20% vs 43%; P = 0.03). However, multivariate statistical analysis revealed that the ATG use was associated with decreased OS and EFS rates and a high incidence of NRM (hazard ratio (HR) = 1.99, 95% confidence interval (CI): 1.11-3.59, P = 0.02), (HR = 1.83, 95% CI: 1.08-3.10, P = 0.02) and (HR = 2.54, 95% CI: 1.03-6.26, P = 0.04), respectively. Therefore, our results do not support the use of ATG as part of a myeloablativeconditioning regimen before single-unit allo-CBT in younger patients with hematological malignancies.

“…Previous studies have reported on ATG in the pretransplantation setting. 15,16 However, none of these reports specifically addressed the impact of ATG on patient outcome.…”

Section: Discussionmentioning

confidence: 99%

Impact of rabbit ATG-containing myeloablative conditioning regimens on the outcome of patients undergoing unrelated single-unit cord blood transplantation for hematological malignancies

Pascal

Mohty

Ruggeri

et al. 2014

“…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

Self Cite

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.

“…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

Self Cite

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.