Unrelated cord blood transplants in adults with hematologic malignancies

Haematologica (Impact Factor: 5.81). 03/2006; 91(2):223-30.
Source: PubMed


We analyzed outcomes and risk factors after unrelated cord blood transplantation (CBT) in adults with hematologic malignancies.
One hundred and seventy-one patients were transplanted after 1997. Their median age was 29 years (15-55), and the median follow-up time was 18 months (1-71). Most patients had acute or chronic leukemia (n=142, 83%), 91 (53%) were transplanted in advanced phase and an autologous transplant had failed in 32 (19%). Most patients (87%) received an HLA-mismatched cord blood unit with 1-2 HLA disparities. At infusion, the median number of nucleated cells and CD34(+) cells was 2.1x10(7)/kg and 1x10(5)/kg, respectively
The cumulative incidence of neutrophil recovery at day 60 was 72+/-3% with a median of 28 days (11-57). A higher neutrophil count and use of hematopoietic growth factors were independently associated with faster neutrophil recovery. The cumulative incidence of grade II-IV acute graft-versus-host disease was 32+/-4% and this complication was not associated with the number of HLA mismatches. The 2-year cumulative incidence of chronic graft-versus-host disease, transplant related-mortality and relapse were 36+/-10%, 51+/-4% and 22+/-4%, respectively. At 2-years, disease-free-survival for patients transplanted in early, intermediate and advanced phases of disease was 41+/-9%, 34+/-10% and 18+/-4%, respectively. In multivariate analyses, advanced disease status was an adverse factor for relapse and disease-free survival.
Unrelated CBT is a clear alternative for adults with hematological malignancies lacking an HLA-matched related or unrelated donor. The choice of units containing a higher neutrophil count and a policy of earlier transplantation are likely to provide better results.

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    • "It is known that larger total nucleated cell (TNC) dose improve faster hematopoietic recovery, decrease treatment-related mortality (TRM) and survival of CBT recipients (Rubinstein et al., 1998; Laughlin et al., 2001; Gluckman et al., 2004; Arcese et al., 2006; Barker et al., 2010). Recent New York Blood Center analysis of 1061 recipients of single-unit myeloablative CBT for leukemia or myelodysplastic syndrome (MDS) demonstrated that TNC dose and HLA-match each affected survival via their effect on TRM (Barker et al., 2010). "

    Acute Leukemia - The Scientist's Perspective and Challenge, 12/2011; , ISBN: 978-953-307-553-2
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    • "In some (Rocha et al, 2000, 2001; Laughlin et al, 2004; Eapen et al, 2007; Atsuta et al, 2009), but not all (Rocha et al, 2004) registry comparative studies, deaths due to infection accounted for a higher proportion of early deaths among CBT patients as compared to URD patients. Several additional studies reported high rates of early TRM largely due to infection among CBT patients, though low infused cell doses and patient selection biases may have confounded these results (Locatelli et al, 1999; Michel et al, 2003; Arcese et al, 2006). A limited number of studies have focused exclusively on comparing rates of infection among CBT patients and patients receiving peripheral blood stem cell transplants (PBSCTs) and bone marrow transplants (BMTs). "
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    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
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    • "Some other aspects related to the CB unit selection and transplantation can be associated with outcomes, however the data published is still preliminary and need confirmation in larger series of patients. ABO major incompatibility has been described to be associated with decreased survival and DFS rates in UCBT for adults with haematological malignancies (Arcese et al, 2006). ABO major incompatibility was also found to be associated with higher TRM after RIC-UCBT in adults with haematological malignancies (Rio et al, 2009). "
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    ABSTRACT: The use of unrelated umbilical cord blood (UCB) as an alternative source of haematopoietic stem cells transplantation (HSCT) has been widely used for patients lacking a human leucocyte antigen (HLA) matched donor. One of the disadvantages of using UCB is the limited number of haematopoietic stem cells and, consequently, delayed engraftment and increased risk of early mortality. Many approaches have been investigated in the attempt to improve engraftment and survival. Among those, studies analysing prognostic factors related to patients, disease, donor and transplantation have been performed. Variable factors have been identified, such as factors related to donor choice (HLA, cell dose and others) and transplantation (conditioning and graft-versus-host disease prophylaxis regimens). This review will focus on the interactions between HLA, cell dose and other modifiable factors related to the UCB unit selection and transplantation that may improve outcomes after UCB transplantation.
    British Journal of Haematology 10/2009; 147(2):262-74. DOI:10.1111/j.1365-2141.2009.07883.x · 4.71 Impact Factor
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