Nelson Chao

Publications (2)24.37 Total impact

• Article: Double unit grafts successfully extend the application of umbilical cord blood transplantation in adults with acute leukemia.

  Andromachi Scaradavou, Claudio G Brunstein, Mary Eapen, Jennifer Le-Rademacher, Juliet N Barker, Nelson Chao, Corey Cutler, Colleen Delaney, Fangyu Kan, Luis Isola, Chatchada Karanes, Mary J Laughlin, John E Wagner, Elizabeth J Shpall
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  ABSTRACT: Cell dose is a major limitation for umbilical cord blood (UCB) transplantation since units containing a minimum of 2.5 x 10(7) total nucleated cells (TNC)/ kilogram patient body weight are frequently not available. The transplantation of two partially HLA-matched UCB units has been adopted as a simple approach for increasing the TNC. We sought to determine whether the relative safety and efficacy of this approach was comparable to a single UCB transplant. Included are adults with acute leukemia transplanted with one (n=106) or two UCB units (n=303). All UCB units for single UCB transplants contained TNC ≥2.5 x 10(7)/kg. For double UCB transplants, the total TNC for units 1 and 2 were greater than 2.5 x 10(7)/kg but in about half of these transplants, one of the two units contained <2.5 x 10(7) TNC/kg. Adjusting for factors associated with outcomes, risks of neutrophil recovery (OR 0.83, p=0.59), transplant-related mortality (HR 0.91, p=0.63), relapse (HR 0.90, p=0.64) and overall mortality (HR 0.93, p=0.62) was similar after double UCB and adequate dose single UCB transplants. These data support double UCB unit transplantation for acute leukemia when an adequately dosed single UCB unit is not available thereby extending access to nearly all patients.
  Blood 12/2012; · 9.90 Impact Factor
• Source

  Available from: Mary J Laughlin

  Article: Effect of graft source on unrelated donor haemopoietic stem-cell transplantation in adults with acute leukaemia: a retrospective analysis.

  Mary Eapen, Vanderson Rocha, Guillermo Sanz, Andromachi Scaradavou, Mei-Jie Zhang, William Arcese, Anne Sirvent, Richard E Champlin, Nelson Chao, Adrian P Gee, Luis Isola, Mary J Laughlin, David I Marks, Samir Nabhan, Annalisa Ruggeri, Robert Soiffer, Mary M Horowitz, Eliane Gluckman, John E Wagner
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  ABSTRACT: Umbilical-cord blood (UCB) is increasingly considered as an alternative to peripheral blood progenitor cells (PBPCs) or bone marrow, especially when an HLA-matched adult unrelated donor is not available. We aimed to determine the optimal role of UCB grafts in transplantation for adults with acute leukaemia, and to establish whether current graft-selection practices are appropriate. We used Cox regression to retrospectively compare leukaemia-free survival and other outcomes for UCB, PBPC, and bone marrow transplantation in patients aged 16 years or over who underwent a transplant for acute leukaemia. Data were available on 1525 patients transplanted between 2002 and 2006. 165 received UCB, 888 received PBPCs, and 472 received bone marrow. UCB units were matched at HLA-A and HLA-B at antigen level, and HLA-DRB1 at allele level (n=10), or mismatched at one (n=40) or two (n=115) antigens. PBPCs and bone-marrow grafts from unrelated adult donors were matched for allele-level HLA-A, HLA-B, HLA-C, and HLA-DRB1 (n=632 and n=332, respectively), or mismatched at one locus (n=256 and n=140, respectively). Leukaemia-free survival in patients after UCB transplantation was comparable with that after 8/8 and 7/8 allele-matched PBPC or bone-marrow transplantation. However, transplant-related mortality was higher after UCB transplantation than after 8/8 allele-matched PBPC recipients (HR 1.62, 95% CI 1.18-2.23; p=0.003) or bone-marrow transplantation (HR 1.69, 95% CI 1.19-2.39; p=0.003). Grades 2-4 acute and chronic graft-versus-host disease (GvHD) were lower in UCB recipients compared with allele-matched PBPC (HR 0.57, 95% 0.42-0.77; p=0.002 and HR 0.38, 0.27-0.53; p=0.003, respectively), while the incidence of chronic, but not acute GvHD, was lower after UCB than after 8/8 allele-matched bone-marrow transplantation (HR 0.63, 0.44-0.90; p=0.01). These data support the use of UCB for adults with acute leukaemia when there is no HLA-matched unrelated adult donor available, and when a transplant is needed urgently.
  The lancet oncology 07/2010; 11(7):653-60. · 14.47 Impact Factor