scholarly journals Prospective Multicenter Study of Single-Unit Cord Blood Transplantation with Myeloablative Conditioning for Adult Patients with High-Risk Hematologic Malignancies

2013 ◽  
Vol 19 (3) ◽  
pp. 486-491 ◽  
Author(s):  
Takehiko Mori ◽  
Masatsugu Tanaka ◽  
Takeshi Kobayashi ◽  
Kazuteru Ohashi ◽  
Shin Fujisawa ◽  
...  
Keyword(s):  
High Risk ◽  
Cord Blood ◽  
Multicenter Study ◽  
Single Unit ◽  
Cord Blood Transplantation ◽  
Hematologic Malignancies ◽  
Adult Patients ◽  
Prospective Multicenter Study ◽  
Myeloablative Conditioning ◽  
Blood Transplantation

Irradiation-Based Myeloablative Cord Blood Transplantation for Hematologic Malignancies In Adults.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4583-4583
Author(s):  
Huilan Liu ◽  
Xingbing Wang ◽  
Liangquan Geng ◽  
Kaiyang Ding ◽  
Baolin Tang ◽  
...  
Keyword(s):  
Cord Blood ◽  
Total Dose ◽  
Research Funding ◽  
Cord Blood Transplantation ◽  
Chronic Gvhd ◽  
Hematologic Malignancies ◽  
Adult Patients ◽  
Pcr Analysis ◽  
Myeloablative Conditioning ◽  
Blood Transplantation

Abstract Abstract 4583 We retrospectively analyzed of the engraftment, Transplant-related complications and survival after unrelated cord blood transplantation (UCBT) using irradiation-based myeloablative conditioning in adult with hematologic malignancies. Between September 2006 and June 2010, 29 consecutive adult patients with hematological malignancies were treated with UCBT, Thirteen of them were advanced-stage disease and 11 of them were high risk or refractory disease. All patients received four fractionated 12 Gy TBI, total dose 12 g/m2 cytarabine and total dose 120 mg/kg cyclophosphamide as myeloablative conditioning. The median age was 21 years; the median weight was 57 kg. Double or multiple UCB grafts were used for 17 patients, while single UCB graft for 12 patients. the median number of nucleated cells was 3.83×107/kg and 5.25×107/kg. All patients were given a combination of cyclosporine A (CsA) and mycophenolate mofetil (MMF) for graft-versus-host disease (GVHD) prophylaxis. All patients obtained engraftment. Median time to neutrophil≥0.5×109/L was 20 days (range 14–37) and platelet engraftment in 25 patients (≥20×109/L) was 35 days (range 25–49). Chimerism was assessed by PCR analysis of short tandem repeat (STR) sequences on whole blood or bone marrow weekly in cases who were fully donor chimeric from 7 days to 21 days after transplantation. 16 cases developed acute GVHD, more than grade II in three cases. Six of twenty-four patients who survived more than 100 days developed limited chronic GVHD.17 cases were alive and in hematologic remission at a median follow-up of 504 days (range 49 ~ 1245). The probability of over survival at 3 years was 58.6%. Five cases relapsed. Nine of twelve cases died of transplant related complications and infection. These results suggest that UCBT after TBI-based myeloablative conditioning could be safely and effectively used for adult patients with hematologic malignancies. Disclosures: Sun: the Fund of the Key Medical Project of Anhui Provincial healthy department (2010A005): Research Funding; the Clinical Technology foundation of Anhui Provincial healthy department (2008A011): Research Funding; the Fund of Anhui Provincial “115” Industrial Innovation Program: Research Funding.

Outcomes of Unrelated Umbilical Cord Blood Transplantation Using a Conditioning Regimen of TBI/Ara-c/CY without ATG for Adolescent and Adults Patients with High-Risk Hematologic Malignancies

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4525-4525
Author(s):  
Zimin Sun ◽  
Huilan Liu ◽  
Liangquan Geng ◽  
Xingbing Wang ◽  
Kaiyang Ding ◽  
...  
Keyword(s):  
High Risk ◽  
Research Funding ◽  
Acute Gvhd ◽  
Cord Blood Transplantation ◽  
Chronic Gvhd ◽  
Conditioning Regimen ◽  
Hematologic Malignancies ◽  
Adult Patients ◽  
Myeloablative Conditioning ◽  
Blood Transplantation

Abstract Abstract 4525 To retrospectively analyze the curative efficacy of umbilical cord blood transplantation (UCBT) using total body irradiation (TBI)-based myeloablative conditioning regimen without antithymocyte globulin (TBI/Ara-c/CY w/o ATG) in adolescent and adult patients with high-risk hematological malignancies. Outcomes of forty-five consecutive adolescent and adult patients with high-risk hematological malignancies treated with TBI-based myeloablative UCBT without ATG in a single center between September 2006 and February 2012 were retrospectively analyzed. The conditioning regimen included TBI/Ara-c/CY:TBI 12GY (four fractionated) + Ara-C 8g/m2 (two days fractionated) + CY 120mg/kg (two days fractionated), and rhG-CSF was administered for myeloid leukemia by continuous infusion at a dose of 5μg·kg−1·d−1. Infusion of G-CSF was started 24 hours before the first dose of Ara-C and stopped at the completion of the last dose. The patients included 31 males and 14 females, with a median age of 21 years (range: 14–40) and a median weight of 58 kg (range: 42–76). Of those, 17 patients (37.8%) had advanced disease. Double UCB grafts were used for 16 patients, while single UCB graft was used for 29 patients. The median number of nucleated cells infused was 3.57 (1.94∼6.76)×107/kg and the median CD34+cells infused was 2.11 (0.71∼4.95)×105/kg. All patients received a combination of cyclosporine (CSA) and mycophenolate mofetil (MMF) for graft-versus-host disease (GVHD) prophylaxis. All patients successfully engrafted. The median times to neutrophil (ANC≥0.5×109/L) and platelet (PLT PLT≥20×109/L) recovery were 19 days (range: 13–35 days) and 36 days (range: 24–90 days) respectively after transplantation in 40 evaluable patients. Acute GVHD occurred in 21 patients and the cumulative incidences of gradeII-‡W and grade III-‡W acute GVHD were 24.4% and 11.1%, respectively. Chronic GVHD occurred in five of 40 evaluable patients (12.5%). Of the 45 patients, 9 (20%) had relapse. After a median follow-up of 25.1 months (range: 6–65.1) among survivors, treatment-related mortality (TRM) within 100 days and within one year was 8.9% and 24.4%, respectively. The main causes of death were pneumonia and severe acute GVHD. The probability of three-year disease-free survival and overall survival (OS) was 53.3% and 57.8%, respectively. The TBI/Ara-c/CY myeloablative conditioning regimen has been well tolerated by patients at our institution and seems to be able to establish sustained donor cell engraftment and decrease the risk of transplant-related death. For high risk patients and patients with advanced disease, this conditioning regimen could reduce relapse and chronic GVHD, indicating the feasibility of TBI/Ara-c/CY as a conditioning regimen for CBT in adolescent and adult patients with hematologic malignancies. Disclosures: Sun: Key Scientific and Technological Project of Anhui province “Twelfth Five-Year Plan” (11010402164): Research Funding; the Fund of the Key Medical Project of Anhui Provincial Healthy Department (2010A005): Research Funding; Anhui Provincial “115” Industrial Innovation Program (2009): Research Funding.

scholarly journals Prognostic Impact of Pre-Transplant Serum C-Reactive Protein in Patients Receiving a Single-Unit Unrelated Cord Blood Transplantation

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5853-5853
Author(s):  
Akiko Negoro ◽  
Heiwa Kanamori ◽  
Jun Aoki ◽  
Satoshi Koyama ◽  
Takayoshi Tachibana ◽  
...  
Keyword(s):  
High Risk ◽  
Cord Blood ◽  
Single Unit ◽  
Cord Blood Transplantation ◽  
Hematologic Malignancies ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Blood Transplantation ◽  
Unrelated Cord Blood ◽  
Serum Crp

Abstract Background: C-reactive protein (CRP) is an acute-phase protein and its serum level rises in response to inflammation. There have been some reports about the relationship between the serum CRP level before allogeneic hematopoietic stem cell transplantation (HSCT) and transplant outcomes. This study particularly evaluated the impact of pre-transplant CRP on the outcome in patients who received a single-unit unrelated cord blood transplantation (UCBT) for hematologic malignancies. Patients and methods: Adult patients receiving UCBT as first HSCT for hematologic malignancies between April 2009 and April 2016 at Kanagawa Cancer Center were retrospectively analyzed in this study. Serum CRP was measured by a latex agglutination assay (normal range 0.0-0.3 mg /dl). The time of measurement was within a few days before the conditioning procedure. Patients were divided into 2 groups according to the serum CRP levels (normal CRP group [≤0.03 mg/dl] and high CRP group [> 0.03 mg/dl)]). A total of 80 patients (pts) included 36 pts with acute myeloid leukemia (AML), 27 pts with acute lymphoid leukemia (ALL), 13 pts with myelodysplastic syndrome (MDS), and 4 pts with others. The median age was 59 years (range, 20-68 years). There were 45 males and 35 females. A disease risk at transplantation indicated a standard risk in 47 pts and a high risk in 33 pts. Myeloablative conditioning (MAC) was employed for 25 pts and reduced intensity conditioning (RIC) was for 55 pts. Data were analyzed with EZR statistical software. Results: The median level of serum CRP at pre-transplant was 0.17 mg/dl (range: 0.01-12.93). No. of patients in normal and high CRP levels was 56 pts and 24 pts, respectively. Disease high risk was significantly associated with a high level of serum CRP. Other pre-transplant factors such as age, gender, diagnosis, comorbidity index, and serum ferritin levels were not related with serum CRP levels. The high incidence of gradeⅡ-Ⅳacute GVHD was significantly associated with high CRP group compared to normal CRP group (55% vs. 19%, p = 0.001). After a median follow-up of 16 months (range: 1-86 months), 3-year overall survival (OS) was 62%. The cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) at 3 years was 26% and 14%, respectively. According to univariate analysis, factors associated with worse 3-year OS included disease high risk at transplantation (vs. low risk; 49% vs. 70%, p = 0.025) and high CRP levels (vs. normal CRP levels; 28% vs. 77%, p < 0.001). Higher 3-year CIR was significantly correlated with high CRP levels (vs. normal CRP levels; 46% vs. 18%, P = 0.009). Adverse factors for NRM was high scores (≥3) of HCT-CI (vs. low scores (≤2) of HCT-CI; 25% vs. 5%, p=0.029). Multivariate analysis showed that high CRP levels (hazard ratio [HR], 4.13; 95% confidence interval [CI], 1.76-9.63; p = 0.001) was an independent determinant of 3-year OS. Prognostic factors related with CIR and NRM was high CRP levels (HR, 2.63; 95%CI, 0.96-7.21; p = 0.059) and high scores of HCT-CI (HR, 4.25; 95%CI, 0.89-20.29; p = 0.069) respectively, but those difference did not reach statistical significance. Conclusions: Pre-transplant serum CRP might be a useful biomarker for predicting the transplant outcome and the development of acute GVHD following UCBT. Disclosures No relevant conflicts of interest to declare.

Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies

Blood ◽  
2004 ◽  
Vol 104 (12) ◽  
pp. 3813-3820 ◽  
Author(s):  
Satoshi Takahashi ◽  
Tohru Iseki ◽  
Jun Ooi ◽  
Akira Tomonari ◽  
Kashiya Takasugi ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Transplantation ◽  
Cord Blood ◽  
Marrow Transplantation ◽  
Cord Blood Transplantation ◽  
Disease Free Survival ◽  
Hematologic Malignancies ◽  
Adult Patients ◽  
Transplant Recipients ◽  
Blood Transplantation

Unrelated cord blood transplantation (CBT) has now become more common, but as yet there have been only a few reports on its outcome compared with bone marrow transplantation (BMT), especially for adults. We studied the clinical outcomes of 113 adult patients with hematologic malignancies who received unrelated BM transplants (n = 45) or unrelated CB transplants (n = 68). We analyzed the hematopoietic recovery, rates of graft-versus-host disease (GVHD), risks of transplantation-related mortality (TRM) and relapse, and disease-free survival (DFS) using Cox proportional hazards models. The time from donor search to transplantation was significantly shorter among CB transplant recipients (median, 2 months) than BM transplant recipients (median, 11 months; P &lt; .01). Multivariate analysis demonstrated slow neutrophil (P &lt; .01) and platelet (P &lt; .01) recoveries in CBT patients compared with BMT patients. Despite rapid tapering of immunosuppressants after transplantation and infrequent use of steroids to treat severe acute GVHD, there were no GVHD-related deaths among CB transplant recipients compared with 10 deaths of 24 among BM transplant recipients. Unrelated CBT showed better TRM and DFS results compared with BMT (P = .02 and P &lt; .01, respectively), despite the higher human leukocyte antigen mismatching rate and lower number of infused cells. These data strongly suggest that CBT could be safely and effectively used for adult patients with hematologic malignancies.

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