BACKGROUND AND OBJECTIVES: We analyzed outcomes and risk factors after unrelated cord blood transplantation (CBT) in adults with hematologic malignancies. DESIGN AND METHODS: 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 RESULTS: 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. INTERPRETATION AND CONCLUSIONS: 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.
BACKGROUND AND OBJECTIVES: We analyzed outcomes and risk factors after unrelated cord blood transplantation (CBT) in adults with hematologic malignancies. DESIGN AND METHODS: 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 RESULTS: 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. INTERPRETATION AND CONCLUSIONS: 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.
Authors: Junya Kanda; David A Rizzieri; Cristina Gasparetto; Gwynn D Long; John P Chute; Keith M Sullivan; Ashley Morris; Clayton A Smith; Donna E Hogge; Janet Nitta; Kevin Song; Donna Niedzwiecki; Nelson J Chao; Mitchell E Horwitz Journal: Biol Blood Marrow Transplant Date: 2010-09-22 Impact factor: 5.742
Authors: U Sobol; A Go; S Kliethermes; S Bufalino; T Rodriguez; S Smith; M Parthasarathy; P Stiff Journal: Bone Marrow Transplant Date: 2015-09-14 Impact factor: 5.483
Authors: Y C Cohen; A Scaradavou; C E Stevens; P Rubinstein; E Gluckman; V Rocha; M M Horowitz; M Eapen; A Nagler; E J Shpall; M J Laughlin; Y Daniely; D Pacheco; R Barishev; L Olmer; L S Freedman Journal: Bone Marrow Transplant Date: 2010-05-03 Impact factor: 5.483
Authors: Matthew R Kudek; Ryan Shanley; Nicole D Zantek; David H McKenna; Angela R Smith; Weston P Miller Journal: Biol Blood Marrow Transplant Date: 2016-08-02 Impact factor: 5.742
Authors: Michael R Verneris; Claudio G Brunstein; Juliet Barker; Margaret L MacMillan; Todd DeFor; David H McKenna; Michael J Burke; Bruce R Blazar; Jeffrey S Miller; Philip B McGlave; Daniel J Weisdorf; John E Wagner Journal: Blood Date: 2009-08-25 Impact factor: 22.113