scholarly journals Effect of HLA-Matching Recipients to Donor Noninherited Maternal Antigens on Outcomes after Mismatched Umbilical Cord Blood Transplantation for Hematologic Malignancy

2012 ◽  
Vol 18 (12) ◽  
pp. 1890-1896 ◽  
Author(s):  
Vanderson Rocha ◽  
Stephen Spellman ◽  
Mei-Jie Zhang ◽  
Annalisa Ruggeri ◽  
Duncan Purtill ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Hematologic Malignancy ◽  
Cord Blood Transplantation ◽  
Umbilical Cord Blood Transplantation ◽  
Hla Matching ◽  
Blood Transplantation ◽  
Noninherited Maternal Antigens

scholarly journals Impact of allele-level HLA matching on outcomes after myeloablative single unit umbilical cord blood transplantation for hematologic malignancy

Blood ◽  
2014 ◽  
Vol 123 (1) ◽  
pp. 133-140 ◽  
Author(s):  
Mary Eapen ◽  
John P. Klein ◽  
Annalisa Ruggeri ◽  
Stephen Spellman ◽  
Stephanie J. Lee ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Single Unit ◽  
Hematologic Malignancy ◽  
Cord Blood Transplantation ◽  
Umbilical Cord Blood Transplantation ◽  
Hla Matching ◽  
Blood Transplantation ◽  
Key Points

Key Points Efficacy of transplanting allele-level HLA-matched cord blood units.

Multiple Unit Umbilical Cord Blood Transplantation with Total Body Irradiation, Etoposide and Antithymocyte Globulin for Adult Hematologic Malignancy Patients.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4344-4344
Author(s):  
Ronald Sobecks ◽  
Edward Copelan ◽  
Matt Kalaycio ◽  
Medhat Askar ◽  
Lisa Rybicki ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Hematologic Malignancy ◽  
Cord Blood Transplantation ◽  
Conditioning Regimen ◽  
Umbilical Cord Blood Transplantation ◽  
Blood Transplantation ◽  
Multiple Unit ◽  
Total Body

Abstract Abstract 4344 Multiple unit umbilical cord blood transplantation (MU-UCBT) has become an acceptable alternative donor transplant approach for adult hematologic malignancy patients without a bone marrow or peripheral blood stem cell donor. Total body irradiation (TBI) and etoposide (VP16) is an effective conditioning regimen for allogeneic hematopoietic stem cell transplantation, but its utility in MU-UCBT has not been well described. From 10/03-2/09 16 adult hematologic malignancy patients were enrolled on a clinical trial at our institution using this regimen prior to MU-UCBT. Patients were eligible if they did not have an HLA matched related or unrelated donor. They also were required to have at least a 4/6 HLA matched UCB unit with at least 0.5 × 107 nucleated cells/kg and a second UCB unit that was at least a 4/6 HLA match with the first UCB unit. The minimum required cryopreserved total nucleated cell (TNC) dose for the combined units was 1 × 107/kg or an infused CD34+ cell dose of 1.5 × 105/kg. Patients received TBI 1,320 cGy (fractionated over days -7 through -4), VP16 60 mg/kg (day -3) and antithymocyte globulin (ATG) 30 mg/kg (days -3 through +1). GVHD prophylaxis consisted of tacrolimus and mycophenolate mofetil. The median age was 47 yrs (range, 18-60) and diagnoses included: 8 AML, 3 CML-accelerated/blast phase, 2 MDS, 1 ALL, 1 CLL 1 NHL. Comorbidity index scores were 9 low, 6 intermediate and 1 high. The median time from diagnosis to UCBT was 8 mos (range, 1-89). HLA match results of the 1st UCB unit infused (UCB1) with the recipient included five 4/6, ten 5/6 and one 6/6 matches, and for the 2nd UCB unit (UCB2) with recipient there were one 3/6, five 4/6, and ten 5/6 matches. The median thawed TNC doses infused for UCB1 and UCB2 were 1.6 × 107/kg (range, 1.0-2.4 × 107/kg) and 1.2 × 107/kg (range, 0.8-2.4 × 107/kg), respectively; the thawed CD34+ cell doses were 0.6 × 105/kg (range, 0.01-2.4 × 105/kg) and 0.6 × 105/kg (range, 0.2-3.1 × 105/kg), respectively. Twelve were evaluable for engraftment analyses; 3 others had early deaths and 1 had graft failure and was rescued with infusion of cryopreserved remission autologous bone marrow. Sustained engraftment in the 12 was observed from a single UCB unit in all cases and the winning unit was UCB1 in 5 (42%). The winning unit had larger median CD8 (p=0.009) and thawed CD34+ cell (p=0.006) doses infused. The median time to achievement of T-cell complete donor chimerism was 30 days (range, 13-139). Median times to neutrophil and platelet engraftment were 20 days (range, 14-48) and 46 days (range, 29-86), respectively. Median time hospitalized was 39 days (range, 20-74). Grade 2-4 and 3-4 acute GVHD developed in 3 pts (19%) and 1 pt (6%), respectively. Chronic GVHD developed in 5 pts (31%) and 4 (25%) were extensive. Graft failure occurred in 2 pts. Six developed CMV infection and 15 developed other infections. There have been 2 (13%) relapses (1 MDS, 1 AML). Eight pts (50%) remain alive at a median follow-up of 15 mos (range, 5-35). Causes of death include 4 infections, 1 graft failure, 1 pulmonary toxicity, 1 CNS bleed, 1 relapse (AML). Incidence of death at 1 and 2 years are 45% (6% relapse, 39% non-relapse) and 59% (6% relapse, 53% non-relapse), respectively. We conclude that the TBI, VP16 and ATG conditioning regimen for MU-UCBT is effective in adult hematologic malignancy patients. Further strategies to enhance immune reconstitution and prevent infections post-transplant are clearly warranted. Disclosures: Off Label Use: Etoposide (VP16) may be considered off-label. Total body irradiation (TBI) and etoposide (VP16) is an effective conditioning regimen for allogeneic hematopoietic stem cell transplantation, but its utility in multiple unit umbilical cord blood transplantation has not been well described. This abstract shares results of a novel trial with TBI/VP/ATG for multiple unit umbilical cord blood transplantation.

scholarly journals The effect of inter-unit HLA matching in double umbilical cord blood transplantation for acute leukemia

Haematologica ◽  
2017 ◽  
Vol 102 (5) ◽  
pp. 941-947 ◽  
Author(s):  
Claudio Brunstein ◽  
Mei-Jie Zhang ◽  
Juliet Barker ◽  
Andrew St. Martin ◽  
Asad Bashey ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Cord Blood Transplantation ◽  
Umbilical Cord Blood Transplantation ◽  
Hla Matching ◽  
Blood Transplantation

The Embt Risk Score Predicts the Outcome of Patients with Leukaemia Receiving Single Umbilical Cord Blood Transplantation

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2275-2275
Author(s):  
Xiaoyu Zhu ◽  
Baolin Tang ◽  
Changcheng Zheng ◽  
Huilan Liu ◽  
Liangquan Geng ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Patient Outcomes ◽  
Relapse Rate ◽  
Risk Score ◽  
Umbilical Cord Blood ◽  
Cord Blood Transplantation ◽  
Umbilical Cord Blood Transplantation ◽  
Hla Matching ◽  
Blood Transplantation

Abstract Aim The European Group for Blood and Marrow Transplantation (EBMT) risk score has been implemented as an important tool to predict patient outcomes following allogeneic haematopoietic stem cell transplantation (allo-HSCT). However, to our knowledge, this score has never been applied in cases of single umbilical cord blood transplantation (sUCBT). The aim of this study was to assess the capacity of the EBMT risk score in predicting the outcomes of patients with leukaemia receiving sUCBT. Methods We retrospectively analysed 218 consecutive patients with leukaemia who received sUCBT at our centre between February 2011 and December 2015. Sixty-eight of the 218 patients had AML, 137 had ALL, 10 had CML, 2 had mixed phenotype AL, and only one patient had plasma cell leukaemia. The median age was 12 years (range, 1-46 years), and the median weight was 40 kg (range, 10-100 kg). All of the patients received an intensified myeloablative conditioning regimen with cyclosporine A (CsA) and mycophenolate mofetil (MMF) as graft-versus-host disease (GVHD) prophylaxis. All of the patients were followed until 31 March 2016, with a median follow-up of 10.7 months (range, 0.5-58.9 months). Results The overall survival (OS) and leukaemia-free survival (LFS) of the entire cohort were 66.8% and 55.4%, respectively, whereas the cumulative incidences of relapse rate and non-relapse mortality (NRM) were 22.4% and 18.0%, respectively. In the univariate analysis, a higher EBMT risk score was associated with worse OS, worse LFS, lower NRM and higher relapse rate, ranging from 80.2%, 74.5%,7.5% and 18.0%, respectively, for patients with a score of 1 to 21.8%, 17.0%, 27.3% and 55.7%, respectively, for patients with a score of 5/6. Hazard ratios of the four indexes all steadily increased for each additional score point. Importantly, the prognostic value of the EBMT risk score on OS, LFS, NRM and relapse was maintained in the multivariate analysis. Moreover, considering the importance of allele-level HLA matching, we developed a modified sUCBT-EBMT risk score using HLA matching situations instead of donor type and found that the modified score could also be used as a predictor for patient outcomes following sUCBT. Conclusions The EBMT risk score is a good predictor of outcomes of patients with leukaemia following sUCBT. The modified sUCBT-EBMT risk score can also be used as a pretransplant risk assessment, but this metric still requires further evaluation with a larger cohort. Disclosures No relevant conflicts of interest to declare.

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