Sarah Nikiforow1, Shuli Li2, Karen Snow3, Deborah Liney4, Grace Shih-Hui Kao5, Richard Haspel6, Elizabeth J Shpall7, Brett Glotzbecker8, R Alejandro Sica9, Philippe Armand8, John Koreth8, Vincent T Ho8, Edwin P Alyea8, Jerome Ritz8, Robert J Soiffer8, Joseph H Antin8, Bimal Dey10, Steven McAfee10, Yi-Bin Chen10, Thomas Spitzer10, David Avigan11, Corey S Cutler8, Karen Ballen10. 1. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: sarah_nikiforow@dfci.harvard.edu. 2. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA. 3. Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA. 4. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. 5. Department of Medical Oncology, Tufts Medical Center, Boston, MA, USA. 6. Harvard Medical School, Boston, MA, USA; Department of Pathology, Beth Israel Deaconess Hospital, Boston, MA, USA. 7. Department of Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA. 8. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. 9. Department of Medical Oncology, University of Illinois, Chicago, IL, USA. 10. Harvard Medical School, Boston, MA, USA; Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA. 11. Harvard Medical School, Boston, MA, USA; Medical Oncology, Beth Israel Deaconess Hospital, Boston, MA, USA.
Abstract
BACKGROUND AIMS: Despite widespread use of umbilical cord blood (UCB) transplantation and distinct practice preferences displayed by individual UCB banks and transplant centers, little information exists on how processing variations affect patient outcomes. METHODS: We reviewed 133 adult double UCB transplants performed at a single center: 98 after reduced-intensity and 35 after myeloablative conditioning. Processing associated with contributing UCB banks and units was surveyed to identify differences in practice. We analyzed effect of selected variables on clinical outcomes of engraftment, dominance, transplant-related mortality, and survival. RESULTS: Eighty-eight percent of banks queried currently practice red blood cell (RBC) depletion before cryopreservation. This reflects a shift in practice because previously 65% of banks employed RBC-replete processing methods (i.e., cryopreservation or plasma/volume reduction). Neither neutrophil nor platelet engraftment was affected by processing conditions analyzed. RBC depletion was not associated with clinical outcomes, except in 17 recipients of 2 RBC-replete units, where survival was better than that observed in 116 recipients of ≥1 RBC-depleted units (hazard ratio 3.26, P = 0.004). When analyzed by attributes of the dominant unit, RBC depletion, time in storage, bank years in existence, and inventory size did not affect clinical outcomes. Postthaw viability and CD34 dose were factors impacting engraftment. Notably, all RBC-replete units in this cohort were washed in dextran-human serum albumin before infusion. DISCUSSION: These findings support continued utilization of the entire existing pool of cord blood units, despite recent trends in processing, and have important implications for banking resources and UCB selection practices.
BACKGROUND AIMS: Despite widespread use of umbilical cord blood (UCB) transplantation and distinct practice preferences displayed by individual UCB banks and transplant centers, little information exists on how processing variations affect patient outcomes. METHODS: We reviewed 133 adult double UCB transplants performed at a single center: 98 after reduced-intensity and 35 after myeloablative conditioning. Processing associated with contributing UCB banks and units was surveyed to identify differences in practice. We analyzed effect of selected variables on clinical outcomes of engraftment, dominance, transplant-related mortality, and survival. RESULTS: Eighty-eight percent of banks queried currently practice red blood cell (RBC) depletion before cryopreservation. This reflects a shift in practice because previously 65% of banks employed RBC-replete processing methods (i.e., cryopreservation or plasma/volume reduction). Neither neutrophil nor platelet engraftment was affected by processing conditions analyzed. RBC depletion was not associated with clinical outcomes, except in 17 recipients of 2 RBC-replete units, where survival was better than that observed in 116 recipients of ≥1 RBC-depleted units (hazard ratio 3.26, P = 0.004). When analyzed by attributes of the dominant unit, RBC depletion, time in storage, bank years in existence, and inventory size did not affect clinical outcomes. Postthaw viability and CD34 dose were factors impacting engraftment. Notably, all RBC-replete units in this cohort were washed in dextran-human serum albumin before infusion. DISCUSSION: These findings support continued utilization of the entire existing pool of cord blood units, despite recent trends in processing, and have important implications for banking resources and UCB selection practices.
Authors: M R Dowling; S Li; B R Dey; S L McAfee; H R Hock; T R Spitzer; Y-B Chen; K K Ballen Journal: Bone Marrow Transplant Date: 2017-11-13 Impact factor: 5.483