Standardized, unrelated donor cord blood transplantation in adults with hematologic malignancies

Abstract

The potential role of unrelated donor cord blood transplantation (UD-CBT) in adults remains unclear. This study reports the results of UD-CBT in 22 adults with hematologic malignancies following conditioning with thiotepa, busulfan, cyclophosphamide, and antithymocyte globulin in 21, with thiotepa, fludarabine, and antithymocyte globulin in 1, and graft-versus-host disease (GVHD) prophylaxis with cyclosporine and prednisone. Median age was 29 years (range, 18-46 years), and median weight was 69.5 kg (range, 41-85 kg). HLA match was 6 of 6 in 1 case, 5 of 6 in 13 cases, and 4 of 6 in 8 cases.Median number of nucleated cells infused was 1.71 ؋ 10 7 /kg (range, 1.01 ؋ 10 7 /kg to 4.96 ؋ 10 7 /kg). All 20 patients surviving more than 30 days had myeloid engraftment, and only 1, who received the lowest cell dose, developed secondary graft failure. Median time to reach an absolute neutrophil count of at least 0.5 ؋ 10 9 /L was 22 days (range, 13-52 days). Median time to platelets numbered at least 20 ؋ 10 9 /L was 69 days (range, 49-153 days). Seven patients (32%) developed acute GVHD above grade II, and 9 of 10 patients at risk developed chronic GVHD, which became extensive in 4 patients.Twelve patients remained alive and diseasefree 3 to 45 months after transplantation. Disease-free survival (DFS) at 1 year was 53%. Age strongly influenced DFS (P ‫؍‬ .01). For patients aged 30 years or younger, the DFS at 1 year was 73%. These preliminary results suggest that UD-CBT should be considered a reasonable alternative in young adults with hematologic malignancy and no appropriate bone marrow donor. (Blood. 2001;98:2332-2338)

Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies

“…On the other hand, previously published literature pointed to infection as a major cause of death. 10,14,25 Despite a high frequency of HLA-mismatched grafts and faster tapering of GVHD prophylactic immunosuppressants in the CBT group, the risk of developing acute GVHD was lower than that in the BMT group, which was significant for grades III and IV severe acute GVHD, as described in other reports. 12,26 The lower incidences of acute GVHD in both BM transplant and CB transplant recipients in our series compared with other reports could be correlated to the higher frequency of the gene that induces higher interleukin-10 production in the Japanese population 27 or are assumed to reflect a lower degree of diversity for HLA and minor histocompatibility antigens among Japanese.…”

“…[1][2][3] While cord blood cells have been increasingly used as a source of hematopoietic stem cells for allogeneic transplantation, most recipients were pediatric [4][5][6][7][8] because of the relatively lower cell doses in cord blood grafts. [4][5][6][7][8] Recently, multicenter and single-center studies of unrelated cord blood transplantation (CBT) in adults after myeloablative 9,10 or nonmyeloablative 11 conditioning regimens showed cord blood could effectively restore hematopoiesis and was associated with acceptable levels of graft-versus-host disease (GVHD). There have also been 2 clinical comparisons of CBT and bone marrow transplantation (BMT) from unrelated donors: one a multicenter study of acute leukemia 12 and the other a single-institution matched-pair analysis.…”

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

“…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.…”

“…2,10,11,21,23,34,36 TRM in adult recipients of UCB after a myeloablative regimen has been reported to be as high as 60%. 7,10,14,17,19,[30][31][32][33] Comparing UCBT to BMT, Rocha et al 22 compared the outcomes of 541 children transplanted for the treatment of acute leukaemia receiving a UCBT (n ¼ 99), unmanipulated BMT (n ¼ 262), or T-cell-depleted BMT (n ¼ 180). UCB recipients were observed to have a higher TRM within the early period after transplantation.…”

Cord blood transplantation in adults

“…As a result of the early successes with pediatric cord blood transplantation (CBT), cord blood from unrelated donors has been increasingly used as an alternative stem cell source for adult patients with hematological malignancies. [1][2][3][4][5][6][7][8][9][10][11][12][13] Recently several reviews including the clinical results of adult CBT have been published. [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] In this review, we focus on recent results of myeloablative CBT in adults.…”