[Show abstract][Hide abstract] ABSTRACT: To describe incidence, risk factors and treatment of autoimmune diseases (AD) occurring after cord blood transplantation (CBT), we analysed CBT recipients reported to EUROCORD having developed at least one new AD and those having not. Fifty-two out of 726 reported patients developed at least one AD within 212 (27-4267) days following CBT. The cumulative incidence of AD after CBT was 5.0±1% at 1 year and 6.6±1% at 5 years. Patients developing AD were younger and had more non-malignant diseases (p<0.001). AD target haematopoietic [autoimmune haemolytic anaemia (n=20), EVANS syndrome (n=9), autoimmune thrombocytopenia (n=11), immune neutropenia (n=1)] and other tissues [thyroiditis (n=3), psoriasis (n=2), Graves' disease (n=1), membranous glomerulonephritis (n=2), rheumatoid arthritis (n=1), ulcerative colitis (n=1) systemic lupus erythematosus (n=1)]. Four patients developed two AD (3 ITP followed by AIHA and 1 EVANS syndrome with rheumatoid arthritis). By multivariate analysis, the main risk factor for developing an AD was non-malignant disease as indication for CBT (p= 0.0001). Haematological AD were most often treated with steroids, rituximab and cyclosporine. With a median follow-up of 26 months (2-91 months), 6/52 patients died as a consequence of AD. CBT may be followed by potentially life-threatening, mainly haematological AD.
[Show abstract][Hide abstract] ABSTRACT: We analyzed risk factors influencing outcomes after related (R) human leukocyte antigen-identical cord blood transplantation (CBT) for 147 patients with malignancies reported to Eurocord-European Group for Blood and Marrow Transplantation. CBT has been performed since 1990; median follow-up was 6.7 years. Median patient age was 5 years. Acute leukemia was the most frequent diagnosis (74%). At CBT, 40 patients had early, 70 intermediate, and 37 advanced disease. CB grafts contained a median of 4.1 × 10(7)/kg total nucleated cells (TNCs) after thawing. The cumulative incidence (CI) of neutrophil recovery was 90% at day +60. CIs of acute and chronic graft-versus-host disease (GVHD) were 12% and 10% at 2 years, respectively. At 5 years, CIs of nonrelapse mortality and relapse were 9% and 47%, respectively; the probability of disease-free survival (DFS) and overall survival were 44% and 55%, respectively. Among other factors, higher TNCs infused was associated with rapid neutrophil recovery and improved DFS. The use of methotrexate as GVHD prophylaxis decreased the CI of engraftment. Patients without advanced disease had improved DFS. These results support banking and use of CB units for RCBT. Cell dose, GVHD prophylaxis not including methotrexate, and disease status are important factors for outcomes after RCBT.
[Show abstract][Hide abstract] ABSTRACT: Unrelated umbilical cord blood (UCB) has been widely used to treat patients lacking a well-matched HLA donor. Cell dose is a critical determinant of outcomes in cord blood transplantation, limiting the use of this strategy for low body weight patients. To overcome this limitation, infusion of two partially HLA-matched cord units was adopted as a new strategy. Since 2005, number of adult patients treated with UCB transplant is increased due to the higher number of cells available using two units and to the feasibility of reduced intensity conditioning regimen, extending successfully this strategy to heavier patients or for those with co-morbidities. Approximately 993 adults with hematological diseases have been transplanted with double UCB graft, and reported to Eurocord registry from 1999 to 2010. This article reviews the state of art and future directions with double umbilical cord blood units as a source of hematopoietic stem cells for transplantation.
Best practice & research. Clinical haematology 06/2010; 23(2):223-9. · 3.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Bone complications after hematopoietic stem-cell transplantation (HSCT) are relatively frequent. Evaluation of biomarkers of bone turnover and dual energy x-ray absorptiometry (DEXA) are not known in this context.
We prospectively evaluated bone mineral density, biomarkers of bone turnover, and the cumulative incidence of bone complications after allogeneic HSCT. One hundred forty-six patients were included. Bone mineral density was measured by DEXA 2-month and 1-year post-HSCT. The markers of bone turnover were serum C-telopeptide (C-TP), 5 tartrate-resistant acid phosphatase (bone resorption), and osteocalcin (bone formation) determined pre-HSCT and 2 months and 1 year thereafter. Potential association between osteoporosis at 2 months, osteoporotic fracture or avascular necrosis and, individual patient's characteristics and biologic markers were tested.
C-TP was high before and 2 months after transplant. At 2 months, DEXA detected osteoporosis in more than half the patients tested. Male sex, median age less than or equal to 15 years, and abnormal C-TP before HSCT were risk factors significantly associated with osteoporosis. Three-year cumulative incidences of fractures and avascular necrosis were 8% and 11%, respectively. Children were at higher risk of fracture, whereas corticosteroid treatment duration was a significant risk factor for developing a clinical bone complication post-HSCT. Bone complications and osteoporosis are frequent after HSCT. Bone biologic markers and DEXA showed that subclinical bone abnormalities appeared early post-HSCT.
The risk factors, age, gender, and C-TP easily available at the time of transplantation were identified. Biphosphonates should probably be given to patients with those risk factors.