Takahashi S, Ooi J, Tomonari A, Konuma T, Tsukada N, Oiwa-Monna M, et al. Comparative single-institute analysis of cord blood transplantation from unrelated donors with bone marrow or peripheral blood stem-cell transplants from related donors in adult patients with hematologic malignancies after myeloablative conditioning regimen. Blood. 2007;109:1322-30

Division of Molecular Therapy, Institute of Medical Science, Department of Biostatistics/Epidemiology and Preventive Health Sciences, School of Health Sciences and Nursing, University of Tokyo, Japan.
Blood (Impact Factor: 10.45). 03/2007; 109(3):1322-30. DOI: 10.1182/blood-2006-04-020172
Source: PubMed


We studied the clinical outcomes of 171 adults with hematologic malignancies who received unrelated cord blood transplantation (CBT) as a primary unrelated stem-cell source (n=100), or bone marrow transplant (BMT) or peripheral blood stem-cell transplant (PBSCT) from related donors (n=71, 55 BMT and 16 PBSCT). All patients received myeloablative regimens including 12 Gy total body irradiation. We analyzed the hematologic recovery, and risks of graft-versus-host disease (GVHD), transplantation-related mortality (TRM) and relapse, and disease-free survival (DFS) using Cox proportional hazards models. Significant delays in engraftment occurred after cord blood transplantation; however, overall engraftment rates were almost the same for both grafts. The cumulative incidences of grades III to IV acute and extensive-type chronic GVHDs among CBT recipients were significantly lower than those among BMT/PBSCT recipients. Multivariate analysis demonstrated no apparent differences in TRM (9% in CBT and 13% in BMT/PBSCT recipients), relapse (17% in CBT and 26% in BMT/PBSCT recipients), and DFS (70% in CBT and 60% in BMT/PBSCT recipients) between both groups. These data suggest that unrelated cord blood could be as safe and effective a stem-cell source as related bone marrow or mobilized peripheral blood for adult patients when it is used as a primary unrelated stem-cell source.

Download full-text


Available from: Tohru Iseki,
  • Source
    • "Numerous studies having shown that HUCBC treatment of rodents does not elicit GVHD (Graft Versus Host Disease), a leading cause of death in patients that have received stem cell transplants (Li et al., 2001b; Lu et al., 2002; Henning et al., 2004; Hu et al., 2006). Patients who receive HUCBC transplants from a relative are significantly at a lower risk of GVHD, and are less likely to reject the transplant compared to either bone marrow or peripheral blood stem cells (Takahashi et al., 2007; Morgado et al., 2008). Factors that may be beneficial to the host brain in vivo are secreted by HUCBderived mononuclear cells as they proliferate and differentiate (Neuhoff et al., 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Ischemic stroke is responsible for many deaths and long-term disability world wide. Development of effective therapy has been the target of intense research. Accumulating preclinical literature has shown that substantial functional improvement after stroke can be achieved using subacutely administered cell-based and pharmacological therapies. This review will discuss some of the latest findings on bone marrow-derived mesenchymal stem cells (BMSCs), human umbilical cord blood cells, and off-label use of some pharmacological agents, to promote recovery processes in the sub-acute and chronic phases following stroke. This review paper also focuses on molecular mechanisms underlying the cell-based and pharmacological restorative processes, which enhance angiogenesis, arteriogenesis, neurogenesis, and white matter remodeling following cerebral ischemia as well as an analysis of the interaction/coupling among these restorative events. In addition, the role of microRNAs mediating the intercellular communication between exogenously administered cells and parenchymal cells, and their effects on the regulation of angiogenesis and neuronal progenitor cell proliferation and differentiation, and brain plasticity after stroke are described.
    Frontiers in Human Neuroscience 06/2014; 8:382. DOI:10.3389/fnhum.2014.00382 · 3.63 Impact Factor
  • Source
    • "As only 30% of patients in need of an allogeneic stem cell transplantation have a fully HLA-matched sibling donor, alternative methods have been explored for HSCs, most notably the use of umbilical CB, which has the distinct advantage of increased availability and potential donor pool due to their permissive immunity, allowing less stringent HLA matching (Barker et al., 2010), while retaining the clinical benefit (i.e. comparable clinical outcome) (Takahashi et al., 2007; Eapen et al., 2007). Yet, the limited amount of HSCs obtained from a single CB, high financial costs and delayed BM reconstitution present ongoing challenges for routine use of CB (reviewed in (Ballen et al., 2012; Brunstein and Wagner, 2006)). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Hematopoietic stem and progenitor cells (HSPCs) continuously egress out of the bone marrow (BM) to the circulation under homeostatic conditions. Their enhanced recruitment to the periphery in response to exogenous stimulation is a process, termed mobilization. HSPC mobilization is induced clinically or experimentally in animal models by a wide variety of agents, such as cytokines (e.g. G-CSF), chemotherapeutic agents (e.g. cyclophosphamide) and small molecules (e.g. the CXCR4 antagonist AMD3100). The major source for clinical transplantation protocols is via peripheral blood (PB) mobilization of BM derived HSPCs. Thus, deciphering mechanisms that regulate HSPC motility can be utilized for the development of improved mobilization regimens. The chemokine stromal derived factor-1 (SDF-1, also termed CXCL12) and its major receptor CXCR4 are crucial in mediating both retention and mobilization of HSPCs, and this chapter will emphasize its recently revealed roles in directing steady state egress and rapid mobilization. Loss of retention is mediated by disruption of adhesion interactions, such as those mediated by integrins and CD44, and intrinsic signaling pathways such as Rho GTPases dependent signaling. Pivotal roles for the hemostatic fibrinolytic and stress-induced proteolytic enzymatic machineries in regulating HSPC recruitment are also discussed. Nevertheless, breakdown of adhesion interactions and activity of proteases are only part of the story, as accumulating evidences present the BM microenvironment, not only as maintaining HSPC quiescence and proliferation, but also as controlling HSPC retention and motility. Differentiating myeloid cells, bone remodeling by osteoblasts and osteoclasts, stimuli of the innate immunity as well as of the nervous system, including signals emanating the circadian clock, highly regulate various aspects of HSPC function, including egress, recruitment and mobilization. This review aims at presenting up to-date results concerning the dynamic interplay between the BM microenvironment and the HSPCs, focusing on molecular mechanisms that lead eventually to mobilization of HSPCs from the BM into the circulation.
    StemBook, 12/2012; Harvard Stem Cell Institute.
  • Source
    • "Previous studies have reported a lower incidence of severe acute GVHD despite commonly used HLA 1 or 2 antigen-mismatched grafts in CBT compared with conventional allo-SCT [5, 13, 29]. However, the sample sizes in these studies were small (18 to 562 patients) and the incidences of grade II-IV acute GVHD varied widely from 26% to 51% [5, 6, 9–13, 15–17, 30]. Hence, further large-scale studies on acute GVHD after CBT are required. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cord blood transplantation (CBT) is an attractive alternative therapy in adult patients with advanced hematological malignancies in whom matched donors are unavailable. However, the risk of complications, especially infections, post-CBT increases the mortality rates in these patients. Although the incidence of acute and chronic graft versus host disease (GVHD) post-CBT is lower than that following bone marrow transplantation and peripheral blood stem cell transplantation (SCT), the additional immunosuppressive therapy required to treat it could increase the mortality in these patients. Further, chronic GVHD following CBT is milder and responds better to treatment than that occurring after bone marrow transplants. Unlike bone marrow transplantation, the onset of GVHD is a positive prognostic indicator of overall survival in patients receiving CBT, due to the graft versus malignancy (GVM) effect. This paper focuses on the immune reactions following CBT and aims to elucidate a management strategy for acute and chronic GVHD.
    06/2011; 2011(2):607569. DOI:10.4061/2011/607569
Show more