Unrelated donor umbilical cord blood transplantation versus unrelated donor bone marrow transplantation in adult and pediatric patients: A meta-analysis

Wang, Jing; Zhan, Ping; Ouyang, Jian; Chen, Bing; Zhou, Rong-Fu; Yang, Yonggong

doi:10.1016/j.leukres.2009.11.020

Cited by 45 publications

(34 citation statements)

References 21 publications

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“…8,9,11,27 It could be speculated that an early specific immune reconstitution post-UCBT may also lead to a more powerful graft-versus-leukemia effect, as suggested in other studies. 2,11,[28][29][30] The number of patients with malignant disease in each group in this study was too small and disease type and conditioning were too heterogeneous to assess this.…”

Section: Discussionmentioning

confidence: 95%

Impact of thymoglobulin prior to pediatric unrelated umbilical cord blood transplantation on immune reconstitution and clinical outcome

Lindemans

Chiesa

Amrolia

et al. 2014

Blood

155

125

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Key Points• For good immune reconstitution and fewer viral reactivations, thymoglobulin should be omitted in cord blood transplants.• Because omission of thymoglobulin is associated with higher acute GVHD rates, further improvement of outcome may require individualized dosing.In vivo T-cell depletion might contribute to the delayed immune reconstitution observed after unrelated umbilical cord blood transplantation (UCBT). We studied the impact of early, late, and no antithymocyte globulin (ATG) on immune reconstitution and outcome. One hundred twenty seven children receiving UCBT in London or Utrecht were divided into 3 groups: early ATG (days 29 to 25; n 5 33), late ATG (days 25 to 0; n 5 48), and no ATG (n 5 46). The no-ATG group received mycophenolate mofetile 1 cyclosporin A as graft-versus-host disease (GVHD) prophylaxis, while the ATG groups received cyclosporin A 1 prednisone. End points studied were survival, immune recovery, infections, and GVHD. The probability of survival was similar in all groups: no ATG, 71% 6 8%; early ATG, 68% 6 9%; and late ATG, 61% 6 7%. CD3 1 , CD4 1 , and CD4 1-naive T-cell counts were significantly higher (P < .001) in the no-ATG group at 1, 2, 3, 6, and 12 months post-UCBT. In the no-ATG group, significantly fewer viral reactivations (P 5 .021) were noted. A higher probability of severe acute GVHD (aGVHD; 31%) was found in the no-ATG group compared with 18% (P 5 .018) for early-ATG and 5% (P < .001) for late-ATG groups. This was not associated with more chronic GVHD (cGVHD). (Blood. 2014;123(1):126-132)

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Section: Discussionmentioning

confidence: 95%

Impact of thymoglobulin prior to pediatric unrelated umbilical cord blood transplantation on immune reconstitution and clinical outcome

Lindemans

Chiesa

Amrolia

et al. 2014

Blood

155

125

View full text Add to dashboard Cite

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“…Other comparative studies have failed to find a difference in acute GVHD rates with cord blood [22]. The impact of cord blood on chronic GVHD risk is less clear, although it appears that cord blood is probably associated with a similar or somewhat lower risk of chronic GVHD compared with marrow or G-PBMC allografts [23-25]. Several groups have reported survival and disease-control rates with umbilical cord blood comparable to those seen with marrow or G-PBMC; such studies were recently reviewed in depth by Sauter and Barker [26].…”

Section: Donor Selection/alternative Donorsmentioning

confidence: 99%

Allogeneic hematopoietic cell transplantation: the state of the art

Gyurkocza

Rezvani

Storb

2010

Expert Review of Hematology

160

129

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Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative procedure for a variety of hematologic malignancies. The field has evolved substantially over the past decade, with advances in patient and donor selection, stem cell sources, supportive care, prevention of complications and reduced-toxicity preparative regimens. As a result, the indications for HCT and the pool of eligible patients have expanded significantly. In this article, we provide an overview of the major aspects of allogeneic HCT, and focus specifically on areas of active research and on novel approaches to challenges in the field. Specifically, we will discuss approaches to reduce the toxicity of the preparative regimen, with the goal of increasing the safety and applicability of HCT. The availability of suitable donors may be an obstacle to wider application of HCT. We review three major approaches to broadening the donor pool: the use of HLA-mismatched unrelated donors, umbilical cord blood and HLA-haploidentical family donors. Graft-versus-host disease remains a major cause of morbidity and mortality after HCT. We review recent advances in the understanding of this phenomenon, and novel prophylactic and therapeutic approaches that hold the promise of further improving the safety of the procedure. We conclude with a speculative outline of the next 5 years of research in the field of HCT. Keywordsbone marrow transplantation; graft-versus-host disease; hematopoietic cell transplantation Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative procedure for a variety of malignant and non-malignant conditions. When developed initially, allogeneic HCT was considered an approach to rescue patients from the toxic side effects of supralethal doses of radiation and chemotherapy used to treat various underlying diseases by transplanting hematopoietic stem cells, which had the ability to reconstitute hematopoiesis. However, it soon became evident that much of the effectiveness of HCT in malignant diseases stemmed from the immunologic reactions of donor cells against malignant host cells.With this recognition, the use of allogeneic HCT has expanded rapidly over the past decades and its role will continue to evolve as advances in conditioning, supportive care, management of complications and expanding stem cell sources further widen its applicability.

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“…However, the DFS rate and relapse incidence in CB recipients were not inferior to those in BM recipients. In a two metaanalysis using pooled comparative data from the above three reports, (Wang et al, 2010). Recently, Eapen et al reported a comparative analysis of CBT from unrelated donor with BMT or peripheral blood stem cell transplantation (PBSCT) from unrelated donors in 1525 adult patients with acute leukemia after myeloablative conditioning (Eapen et al, 2010).…”

Section: Comparisons Of Unrelated Donor Cord Blood and Other Stem Celmentioning

confidence: 99%

Cord Blood Transplantation in Adults with Acute Leukemia

Konuma¹,

Takahashi²

2011

Acute Leukemia - The Scientist's Perspective and Challenge

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Unrelated donor umbilical cord blood transplantation versus unrelated donor bone marrow transplantation in adult and pediatric patients: A meta-analysis

Cited by 45 publications

References 21 publications

Impact of thymoglobulin prior to pediatric unrelated umbilical cord blood transplantation on immune reconstitution and clinical outcome

Impact of thymoglobulin prior to pediatric unrelated umbilical cord blood transplantation on immune reconstitution and clinical outcome

Allogeneic hematopoietic cell transplantation: the state of the art

Cord Blood Transplantation in Adults with Acute Leukemia

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