Increasing recipient age is a well-known risk factor for graft-versus-host disease (GVHD) and treatment-related mortality (TRM) and has a negative impact on allogeneic hematopoietic stem cell transplantation. Since the incidence of severe GVHD after cord blood transplantation (CBT) is lower than that after transplants using bone marrow or mobilized peripheral blood grafts from adult cells, we should expect better outcomes from CBT in older patients. To evaluate the feasibility and efficacy of myeloablative unrelated CBT in patients aged between 50 and 55 years, we performed a retrospective comparison of 100 patients with acute leukemia who received cord blood grafts at our institution. Nineteen older patients (median age, 52; range, 50-55) and 81 younger patients (median, 36; range, 16-49) received a myeloablative conditioning regimen including 12 Gy of total body irradiation and chemotherapy. GVHD prophylaxis included cyclosporine with (n = 96) or without (n = 4) methotrexate. There were no significant differences in the incidences of grades II to IV acute GVHD, extensive-type chronic GVHD, TRM, and the probability of overall and disease-free survival between these groups. These results suggest that, in patients with acute leukemia, myeloablative CBT might be as safe and effective in patients aged between 50 and 55 years as in younger patients.
"Clinical study comparing haploidentical HSCT to CBT are warranted. Reports of disease-specific outcomes for adult patients with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL) after CBT are still limited (Ooi et al., 2004, 2008, 2009; Konuma et al, 2009a "
"As long as cell dose and HLA matching thresholds are met, more recent series consistently report >90% engraftment rates following myeloablative TBI-based conditioning (Barker et al, 2005a; Okada et al, 2008; Ooi et al, 2008, 2009), however, the toxicity of TBI-based regimens limits their widespread use. A recent Japanese report describes comparable outcomes among CBT patients with no marked organ dysfunction aged 50– 55 years receiving 12 Gy TBI-based conditioning regimens versus younger patients receiving similar regimens (Konuma et al, 2009), however, the toxicity of TBI increases with age. At our centre, the current upper age limit for our TBI-based CBT conditioning regimen is 45 years. "
[Show abstract][Hide abstract] ABSTRACT: Growing evidence supports the efficacy of cord blood transplantation (CBT) to treat patients with haematological malignancies, and the number of CBTs is rapidly increasing. Herein, we review considerations regarding conditioning regimens for CBT, the impact of double unit transplantation on CBT outcomes, and data regarding infectious complications following CBT.
British Journal of Haematology 10/2009; 147(2):207-16. DOI:10.1111/j.1365-2141.2009.07782.x · 4.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Dramatic advances in the field of stem cell research have raised the possibility of using these cells to treat a variety of diseases. The eye is an excellent target organ for such cell-based therapeutics due to its ready accessibility, the prevalence of vasculo- and neurodegenerative diseases affecting vision, and the availability of animal models to demonstrate proof of concept. In fact, stem cell therapies have already been applied to the treatment of disease affecting the ocular surface, leading to preservation of vision. Diseases in the back of the eye, such as macular degeneration, diabetic retinopathy, and inherited retinal degenerations, present greater challenges, but rapidly emerging stem cell technologies hold the promise of autologous grafts to stabilize vision loss through cellular replacement or paracrine rescue effects.
The Journal of clinical investigation 09/2010; 120(9):3012-21. DOI:10.1172/JCI42951 · 13.22 Impact Factor
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