Unrelated donor cord blood transplantation in adults with chronic myelogenous leukemia: results in nine patients from a single institution

Abstract

Summary:The potential role of unrelated donor cord blood transplantation (UD-CBT) in adults is not well established. We report the results of UD-CBT in nine adult patients with chronic myeloid leukemia (CML). The median age was 27 years (range, 19-41 years), and the median weight was 62 kg (range, 45-78 kg). At transplant, six patients were in chronic phase (five in first, and one in second), two in blast crisis, and one in accelerated phase. Eight had received intensive chemotherapy, and three had undergone autologous peripheral blood hematopoietic stem cell transplantation. Four had received interferon with no cytogenetic response, and only three underwent UD-CBT within 1 year of diagnosis. After serological typing for class I antigens, and high-resolution DNA typing for DRB1, the degree of HLA match between patients and cord blood (CB) units was 4/6 in six cases and 5/6 in three cases. The median number of nucleated cells infused was 1.7 × 10 7 /kg (range, 1.2 to 4.9 × 10 7 /kg), and was above 2 × 10 7 /kg in only two cases. All patients received thiotepa, busulfan, cyclophosphamide and anti-thymocyte globulin as conditioning; cyclosporine and prednisone for graft-versushost disease (GVHD) prophylaxis; and G-CSF from day +7 until engraftment. All seven evaluable cases engrafted. The median time to reach an absolute neutrophil count у0.5 × 10 9 /l and у1 × 10 9 /l was 22 days (range, 19-52 days) and 28 days (range, 23-64 days), respectively. In the four patients evaluable for platelet recovery time to levels of у20 × 10 9 platelets/l, у50 × 10 9 platelets/l, and у100 × 10 9 platelets/l, these ranged from 50 to 128 days, 60 to 139 days, and 105 to 167 days, respectively. Three patients developed acute GVHD above grade II, and three of the five patients at risk developed extensive chronic GVHD. Four patients, all transplanted in chronic phase, remain alive in mol-

Early infections in adult patients undergoing unrelated donor cord blood transplantation

“…Eligibility criteria for UD-CBT, the criteria for selection of a CB unit, and the techniques used for HLA typing of patients and CB grafts have been described elsewhere. 4,5 Preparative regimen and GVHD prophylaxis Twenty-six patients were conditioned with thiotepa, busulfan, cyclophosphamide and antithymocyte globulin (ATG), as described in detail elsewhere. 4,5 The remaining patient was treated with a conditioning regimen of reduced intensity, consisting of fludarabine, thiotepa, and ATG.…”

“…4,5 Preparative regimen and GVHD prophylaxis Twenty-six patients were conditioned with thiotepa, busulfan, cyclophosphamide and antithymocyte globulin (ATG), as described in detail elsewhere. 4,5 The remaining patient was treated with a conditioning regimen of reduced intensity, consisting of fludarabine, thiotepa, and ATG. 4 Subcutaneous filgrastim (Amgen, Thousand Oaks, CA, USA) was administered to all patients from day 7 after transplant in an attempt to shorten the time to engraftment.…”

Unrelated donor umbilical cord blood transplantation in adults

“…It has been speculated that the clinical pattern of chronic GVHD after UD-UCBT could be somewhat different to that usually seen after UD-BMT. 28 …”

“…14 Anecdotal case reports of UD-UCBT and small series comprising less than 10 patients have not been taken into consideration. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] To comprehend the extraordinary increase in UD-UCBT activity in recent years, we should note that, as of December 1997, a review of reports in the literature 31 collected data from only 43 recipients of UD-UCBT, of whom only four were adults. In fact, the first report of UD-UCBT in an adult patient with chronic myelogenous leukemia was published in 1996.…”

Platelet glycoprotein complex Ia/IIa antibodies cause neonatal alloimmune thrombocytopenia but do not inhibit megakaryopoiesis and platelet recovery after allogeneic cord blood stem cell transplantation

“…[19][20][21] The platelet recovery time of 30 days with identical platelet levels (Ͼ50 000/l) in this case was very fast. Therefore, from the clinical point of view, one may conclude that megakaryopoiesis and platelet recovery were normal after this CB transplantation.…”