scholarly journals Bloodstream Infection after Umbilical Cord Blood Transplantation Using Reduced-Intensity Stem Cell Transplantation for Adult Patients

2005 ◽  
Vol 11 (6) ◽  
pp. 429-436 ◽  
Author(s):  
Hiroto Narimatsu ◽  
Tomoko Matsumura ◽  
Masahiro Kami ◽  
Shigesaburo Miyakoshi ◽  
Eiji Kusumi ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cord Blood ◽  
Bloodstream Infection ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Cord Blood Transplantation ◽  
Umbilical Cord Blood Transplantation ◽  
Blood Transplantation ◽  
Reduced Intensity

Successful engraftment after reduced-intensity umbilical cord blood transplantation for myelofibrosis

Blood ◽  
2010 ◽  
Vol 116 (4) ◽  
pp. 649-652 ◽  
Author(s):  
Shinsuke Takagi ◽  
Yasunori Ota ◽  
Naoyuki Uchida ◽  
Koichi Takahashi ◽  
Kazuya Ishiwata ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Cord Blood Transplantation ◽  
Donor Cell ◽  
Umbilical Cord Blood Transplantation ◽  
Hematopoietic Stem ◽  
Blood Transplantation ◽  
Marrow Fibrosis ◽  
Reduced Intensity

Abstract Although allogeneic hematopoietic stem cell transplantation has recently been applied to patients with myelofibrosis with reproducible engraftment and resolution of marrow fibrosis, no data describe the outcomes of umbilical cord blood transplantation. We describe 14 patients with primary (n = 1) and secondary myelofibrosis (n = 13) who underwent reduced-intensity umbilical cord blood transplantation. Conditioning regimens included fludarabine and graft-versus-host disease prophylaxis composed cyclosporine/tacrolimus alone (n = 6) or a combination of tacrolimus and mycophenolate mofetil (n = 8). Thirteen patients achieved neutrophil engraftment at a median of 23 days. The cumulative incidence of neutrophil and platelet engraftment was 92.9% at day 60 and 42.9% at day 100, respectively. Posttransplantation chimerism analysis showed full donor type in all patients at a median of 14 days. The use of umbilical cord blood could be feasible even for patients with severe marrow fibrosis, from the viewpoint of donor cell engraftment.

Allele Matching At HLA-C or DRB1 Is Associated with Improved Survival After Reduced Intensity Double Umbilical Cord Blood Transplantation

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2010-2010 ◽  
Author(s):  
Alfred L. Garfall ◽  
Haesook T Kim ◽  
Corey Cutler ◽  
Vincent T Ho ◽  
John Koreth ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Cord Blood Transplantation ◽  
Umbilical Cord Blood Transplantation ◽  
Unit Selection ◽  
Blood Transplantation ◽  
Number Of Patients ◽  
The Impact ◽  
Reduced Intensity

Abstract Abstract 2010 Mismatch at HLA-C has been associated with increased transplant-related mortality in unrelated bone marrow and peripheral blood stem cell transplantation as well as single myeloablative umbilical cord blood transplantation (UCBT) in children, but the impact of HLA-C mismatch in adult double reduced-intensity conditioning (RIC) UCBT is unknown. Matching at HLA-C is not routinely considered in cord unit selection. We studied the effect of HLA-C matching in 125 patients who underwent double UCBT for hematologic malignancy at Dana-Farber Cancer Institute and Massachusetts General Hospital from 2003 through 2010. The median age was 49 years (range 16–69), and the diagnoses included acute leukemia (45%), MDS (12%), lymphoma (27%), myeloproliferative neoplasms (2%), and others (13%). Data on HLA-C match were recorded but not used in the UCB unit selection strategy. UCB unit selection criteria were a 4/6 allele level A, B, DR match with the patient and other UCB unit. 82% of patients received a fludarabine/melphalan/antithymocyte globulin RIC, and 62% received sirolimus-based graft vs host disease (GVHD) prophylaxis. The median follow-up time among survivors was 32 months (range 6–73). The degree of allele matching at HLA-C (donor to both cords) was 0/4 in 14 patients (11%), 1/4 in 21 patients (17%), 2/4 in 62 patients (50%), 3/4 in 20 patients (16%), and 4/4 in 8 patients(6.4%). Patients who received 2 UCB units both with > 6/8 match at HLA-A,-B,-C, and -DRB1 had improved survival (3 year overall survival (OS) 56% vs 29%, p= 0.01). There was a significant correlation between degree of matching at HLA-C and the frequency of neutrophil engraftment (ANC > 500 by day 42) (0/4=79%, 1/4=76%, 2/4=71%, 3/4=80%, 4/4=100%; p=0.004). Similarly, matching at HLA-C was significantly correlated with platelet engraftment (plt>20,000 by day 100) (0/4=50%, 1/4=52%, 2/4=57%, 3/4=70%, 4/4=100%; p=0.0004). Matching at HLA-A,-B, or –DRB1 did not correlate with engraftment. There was no effect of matching at HLA-C on relapse, acute GVHD, or chronic GVHD. A full match at HLA-C (4 alleles) was associated with improved survival (3-year OS 67% vs 33% with less than full match, p=0.05) but there only 8 patients who received 2 HLA-C matched UCB units. Degree of match individually at HLA-A,-B, or DRB1 was not alone associated with survival. When various combinations of match were examined, full matching at either HLA-C or full matching at HLA-DRB1 (with less than full matching at HLA-C), compared to full matching at neither locus, was associated with improved 3-year OS (67% vs. 42% vs. 24%, p=0.03). HLA-C match did not predict the dominant UCB unit. In summary, (1) patients who received closer HLA allele-level matched UCB units had improved survival after RIC double UCBT; (2) matching at HLA-C in RIC double UCBT may be associated with earlier neutrophil and platelet engraftment; (3) survival may be improved when patients received UCB units fully matched at HLA-C or fully matched at HLA-DRB1 (if less than fully matched at HLA-C) compared to recipients of units fully matched at neither locus; and (4) matching at HLA-A,-B, or DRB1 alone did not correlate with differences in engraftment or survival. These data are limited by the small number of patients that were compatible at HLA-C but warrant examination in a larger cohort to determine the role of matching at HLA-C in UCB unit selection algorithms. Disclosures: Soiffer: Genzyme: Consultancy; Fresenius biotech: Research Funding; Miltenyi Biotech: Consultancy.

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