scholarly journals Unmanipulated Bone Marrow As Third Party Donor for Unrelated Cord Blood Transplant Decreases 100-Day Mortality in Children

2015 ◽  
Vol 21 (2) ◽  
pp. S305-S306
Author(s):  
Oscar Ramirez ◽  
Margarita Quintero ◽  
Carlos Andres Portilla ◽  
Eduardo Lopez ◽  
Viviana Lotero ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cord Blood ◽  
Third Party ◽  
Cord Blood Transplant ◽  
Unrelated Cord Blood

Outocomes of Second Unrelated Cord Blood Transplant for Relapse After First Allogeneic Transplant In Adult Patients with Progressive Acute Myeloid Leukimia/Myelodysplastic Syndrome.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1295-1295
Author(s):  
Sachi Tainosho ◽  
Kazuhiro Masuoka ◽  
Aya Nishida ◽  
Nobuaki Nakano ◽  
Kazuya Ishiwata ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Mortality Rate ◽  
Myelodysplastic Syndrome ◽  
Cord Blood ◽  
Progressive Disease ◽  
Adult Patients ◽  
Cord Blood Transplant ◽  
Unrelated Cord Blood ◽  
Related Mortality ◽  
Acute Myeloid

Abstract Abstract 1295 <Objective> Disease relapse following allogeneic hematopoietic stem cell transplant (allo-HSCT) remains a major cause of treatment failure, often with a poor outcome. Some recent reports have demonstrated successful treatment receiving 2nd allo-HSCT with bone marrow (BM) and peripheral blood (PB) following relapse. However, there are few reports about unrelated cord blood transplant (UCBT). Therefore, we retrospectively analyzed the results of 2nd allo-HSCT using UCB for 34 adult patients with acute myeloid leukemia (AML) / myelodysplastic syndrome (MDS), who relapsed after 1st HSCT. <Patients and methods> We reviewed medical records of 130 adult patients with AML/MDS who received 1st HSCT between March 2006 and May 2009 at Toranomon Hospital, Tokyo, Japan. Fifty-three of these patients relapsed after 1st allo-HSCT including 12 recipients of related peripheral blood (RPB), 13 unrelated bone marrow (UBM) and 28 UCB. In these relapsed patients, 34 proceeded to 2nd transplant with UCB. The remaining 19 patients did not receive 2nd transplants because of severe organ dysfunction or uncontrolled active infection and continued complete remission by donor lymphocyte infusion. The median age at 2nd UCBT was 54 years (18-69) and interval between 1st allo-HSCT and 2nd UCBT was 9 months (1-54). Diagnoses include de novo AML (n=21) and MDS overt AML (n=13). Disease status at 1st allo-HSCT were as follows; 4 patients in CR, 25 patients in chemo-refractory and 5 patients in progressive desease without chemotherapy. All patients at 2nd UCBT were in progressive disease. All patients received a single cord blood unit with median TNC/CD34 cell dose of 2.8×107/kg (range, 1.4–4.8) and 0.7×105/kg (range, 0.2–2.2), respectively. HLA disparities were 3/6 match (n=4), 4/6 (n=25), 5/6 (n=4) and 6/6 (n=1). Conditioning regimen consisted of fludarabine and alkylating agent. Graft-versus-host disease (GVHD) prophylaxis consisted of tacrolimus (Tac) alone in 15, Tac plus mycophenolate mofetil in 11, and cyclosporine alone in 8. <Results> Ten patients died by day 28 because of progressive disease (n=5) and transplant related mortality (n=5) and 21 of 24 patients, who survived more than 28 days, were engrafted with complete donor type chimerism (median 19 days). Acute GVHD developed in 14, and chronic GVHD in 4 of these 21 engrafted patients. Estimated 3-year over all survival (OS), transplant related mortality rate and relapse mortality rate were 16%, 32%, and 52%. In univariate analysis, a variable associated with worsened survival were early relapse within 100 days after 1st allo-HSCT (0 vs 21% in late relapses; P=0.01), while other factors were not significant. Eighteen of 19 patients who did not undergo 2nd UCBT died of progressive disease or multiple organ failure. <Conclusion> 3 year-OS of 16% with 2nd UCBT following relapsed AML/ MDS was comparable with that of 2nd BMT or PBCST. Considering that all patients in this study were in non-remission and in relatively higher age (median age 54 years), 2nd UCBT following relapse of AML/MDS could be a viable therapeutic option. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Results of Unrelated Cord Blood Transplant in Fanconi Anemia Patients: Risk Factor Analysis for Engraftment and Survival

2007 ◽  
Vol 13 (9) ◽  
pp. 1073-1082 ◽  
Author(s):  
Eliane Gluckman ◽  
Vanderson Rocha ◽  
Irina Ionescu ◽  
Marc Bierings ◽  
Richard E. Harris ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Risk Factor ◽  
Cord Blood ◽  
Fanconi Anemia ◽  
Risk Factor Analysis ◽  
Cord Blood Transplant ◽  
Unrelated Cord Blood

Efficacy and safety of micafungin in unrelated cord blood transplant recipients

2019 ◽  
Vol 98 (11) ◽  
pp. 2593-2600
Author(s):  
Takeo Yasu ◽  
Takaaki Konuma ◽  
Maki Oiwa-Monna ◽  
Mai Mizusawa ◽  
Masamichi Isobe ◽  
...  
Keyword(s):  
Cord Blood ◽  
Efficacy And Safety ◽  
Transplant Recipients ◽  
Cord Blood Transplant ◽  
Unrelated Cord Blood

Unrelated Cord Blood Cell Transplantation for Acquired Severe Aplastic Anemia: The Report from the Japan Cord Blood Bank Network.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2020-2020
Author(s):  
Seiji Kojima ◽  
Ayami Yoshimi ◽  
Shuichi Taniguchi ◽  
Junichi Hara ◽  
Toshimitsu Matsui ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cord Blood ◽  
Aplastic Anemia ◽  
Cumulative Incidence ◽  
Cord Blood Transplantation ◽  
Conditioning Regimen ◽  
Severe Aplastic Anemia ◽  
Bone Marrow Donor ◽  
Grade Ii ◽  
Unrelated Cord Blood

Abstract Treatment approaches for patients with severe aplastic anemia (SAA), who failed immunosuppressive therapy and lack a bone marrow donor remains a great challenge. Unrelated cord blood transplantation (UCBT) has not been recommended for SAA because of historical poor outcome with high rate of engraftment failure. To evaluate the current feasibility of UCBT in SAA, we retrospectively analyzed the outcomes of 31 patients (median age 28 years old; ranged 0.9–72.3 years old) with SAA, who received UCBT as the first graft between 1998 and 2006 in Japan. Median disease duration before UCBT was 337 day (31–5063 days). By serology, HLA loci were matched in 4 recipient-donor pairs and mismatched (1–2 loci) in 27 patients. A minimum cell count of 2 × 107 nucleated cells/kg body weight was infused in all patients. Engraftment was observed in 17 of 24 evaluable patients. The median times to achieve a neutrophil count ≥ 0.5 × 109/l and a platelet count ≥ 50 × 109/l were 19 days (range 12–35 days) and 59 days (range 39–145 days), respectively. The results of chimerism analysis were available in 9 of them and all of them showed complete donor chimerism (&gt;99%) except one with autologous recovery. Late rejection was seen in one patient. Acute GVHD (≥ grade II) was observed in 5 of 18 evaluable patients (grade II; n=4, grade III; n=1) (cumulative incidence =17.1%) and chronic GVHD was observed in 4 of 14 evaluable patients (extensive: n=1, limited: n=3) (cumulative incidence =19.7%). Currently, 13 patients are alive, having survived for median 22.5 months (ranged 3 to 77 months) after UCBT (overall survival at 2 years=40%). Causes of death of 18 patients were following: graft failure (n=7), bacterial/fungal infections (n=3), hepatic veno-occlusive disease (n=3), and others (n=5). The conditioning regimen appeared to be the most important factor for the outcome and low dose total body irradiation (2–4 Gy) + fludarabine (90–250/ mg/m2) and cyclophosphamide (50–100 mg/kg or 2250/mg/m2) (n=5) gave the best outcome with 80% of survival. The GVHD prophylaxis with single agent (cyclosporine or tacrolimus) related with a better engraftment rate than 2 or more agents (84.4% vs 47.3%, p=0.02). These results suggest that UCBT can be a salvage treatment for patients without a bone marrow donor and warrant further evaluation in prospective studies. Optimization of conditioning regimen will improve the engraftment and outcome of UCBT.

The Effect of Obesity On Outcome of Unrelated Cord Blood Transplant in Children with Malignant Diseases.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2278-2278
Author(s):  
S. Pine Meghann ◽  
Li Wang ◽  
Frank Harrell ◽  
Richard Ho ◽  
Jennifer Domm ◽  
...  
Keyword(s):  
Cord Blood ◽  
Performance Status ◽  
Chronic Gvhd ◽  
Hla Antigens ◽  
Normal Weight ◽  
Obese Patients ◽  
Malignant Diseases ◽  
Cord Blood Transplant ◽  
Cord Blood Unit ◽  
Unrelated Cord Blood

Abstract Abstract 2278 Poster Board II-255 Obesity has become a pandemic in the US, affecting both children and adults. In the adult population, evidence suggests that obesity has an adverse impact on outcomes of hematopoietic stem cell transplant for various malignancies. We investigated the influence of obesity on children undergoing unrelated cord blood transplant utilizing data from the Cord Blood Transplant Study. To our knowledge, no data exists on the effect obesity has on key prognostic indicators for cord blood transplant for malignant diseases in children. There were 191 patients '18 years of age with malignant diseases prospectively enrolled on a National Heart Lung Blood Institute (NHLBI) sponsored cord blood transplant study between 1999 and 2003. Data set was obtained after signed agreement with the NHLBI and local IRB approval. All patients received myeloablative preparative regimens with either total body irradiation and cyclophosphamide (N=172) or busulfan and melphalan (N=19). In addition, all patients received anti-thymocyte globulin as part of their conditioning regimens. Graft versus host disease (GVHD) prophylaxis included cyclosporine and prednisone. Children were classified into groups according to body mass index (BMI) percentile. Normal weight was defined as BMI between the 5th and 85th percentile, overweight between the 85th and 95th percentile, obesity above 95th percentile for age and gender according to the Center for Disease Control and Prevention (CDC) guidelines. For the overall survival (OS) and disease free survival (DFS), the Cox regression model was used to test the effect of BMI while controlling for age, gender, performance status (<90 versus ≥90), HLA match (≤4/6 versus ≥5/6 HLA match), total nucleated cell count (TNC) per kg infused and CMV status. For neutrophil and platelet engraftment, transplant related mortality (TRM), grade II-IV acute GVHD, and chronic GVHD, competing risks regression analyses were used to test effect of BMI while controlling for other covariates. The median age was 7.59 years (range 2.07 – 17.90) with 113 (59%) male. 160 patients (84%) had a performance status of ≥90. 51 patients (27%) had acute myelogenous leukemia (AML), 109 patients (57%) had acute lymphoblastic leukemia (ALL) and 30 patients (16%) had other malignant diseases. 119 patients (62%) received a cord blood unit matched at 3/6 or 4/6 HLA antigens and 72 patients (38%) received a cord blood unit matched at 5/6 or 6/6 HLA antigens. The median TNC per kg infused was 5.2 × 107/kg (range 0.15-80.9 × 107/kg). Of the 191 total patients who were classified by their BMI percentiles, 117 patients (61%) were normal weight, 35 patients (18%) were overweight and 39 patients (20%) were obese. The two groups were not significantly different in sex distribution (p=0.25), diagnosis (p=0.13), performance status (p=0.91), median TNC received (p=0.49) or CMV status (p=0.47). Obese patients were significantly younger with a median age of 5.7 years compared to 8.9 years in normal weight children (p=0.002). Time to neutrophil and platelet engraftment, TRM, risk of grade II-IV acute GVHD, DFS and OS were not significantly different in overweight or obese patients compared to normal weight patients. There was a trend towards increased risk of chronic GVHD in obese patients (p=0.045) compared to normal weight patients. In conclusion, obesity has no significant effect on multiple outcomes after unrelated cord blood transplant in children with malignant diseases. Disclosures: No relevant conflicts of interest to declare.

Unrelated Cord Blood Does Not Increase An Overall Risk Of Invasive Fungal Infections Compared To Unrelated Bone Marrow: A Single Center Retrospective Analysis For 749 Recipients

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4541-4541 ◽  
Author(s):  
Yuki Asano-Mori ◽  
Hideki Araoka ◽  
Muneyoshi Kimura ◽  
Daisuke Kaji ◽  
Hikari Ota ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Cord Blood ◽  
Cumulative Incidence ◽  
Fungal Infections ◽  
Chronic Gvhd ◽  
Antifungal Prophylaxis ◽  
Invasive Fungal Infections ◽  
Systemic Corticosteroids ◽  
Grade Ii ◽  
Unrelated Cord Blood

Background Invasive fungal infections (IFIs) are of great concern after allogeneic hematopoietic stem cell transplantation (HSCT), the risk of which is considered to be particularly prominent among cord blood transplantation (CBT) recipients. Patients and Methods We retrospectively analysed the records of 749 adult patients who underwent CBT or unrelated bone marrow transplantation (uBMT) for the first time at the Toranomon Hospital between 2002 and 2012, and who had neither prior history nor suspicious findings of IFIs. As prophylaxis for IFIs, fluconazole (FLCZ) or itraconazole (ITCZ) capsules were conventionally used until around 2006, which were then changed to newer mold-active agents including ITCZ oral solution, voriconazole or micafungin after their approval in Japan, the choice of which was subjected to physician's discretion. Results Engraftment achieved in 418 CBT patients and 198 uBMT patients with a significantly longer neutropenic period in CBT patients (median 20 days vs 18 days, P<0.001), whereas 37 patients underwent re-transplantation and 96 died before engraftment. The incidences of grade II-IV acute graft-versus-host disease (GVHD) and extensive chronic GVHD were significantly less frequent after CBT compared to uBMT (40% vs 54% and 17% vs 46%, both P<0.001). Systemic corticosteroids at ≥0.5mg/kg/day was given in fewer CBT patients compared to uBMT patients (59% vs 66%, P=0.07). The median durations of immunosuppressants and antifungal prophylaxis were significantly shorter in CBT patients compared to uBMT patients (118 days vs 302 days and 315 days vs 491 days, both P<0.001). As prophylaxis for IFIs, 194 CBT patients and 91 uBMT patients received FLCZ/ITCZ capsules, while 341 CBT patients and 123 uBMT patients received newer mold-active agents. Seventy-nine patients (57 in CBT and 22 in uBMT) developed IFIs with a cumulative incidence of 12.2%, at a median of 27 (1-1646) days after HSCT. About 60% of the patients developed IFIs by day 50 and the percentage reached more than 90% until 1 year. The median onset was significantly earlier in CBT patients compared to uBMT patients (day 19 vs day 61, P=0.007). The cumulative incidence of IFIs was significantly higher in CBT patients compared to uBMT patients during 50 days after HSCT (7.9% vs 3.8%, P=0.04), but became significantly lower thereafter until 1 year (2.7% vs 6.9%, P=0.02), and an overall incidence was almost similar between the 2 groups (12.6% vs 11.6%, P=0.58) (Figure 1). Four patients had 2 infectious episodes caused by different fungal species, and a total of 83 infectious episodes were documented. Eighty-one cases were breakthrough infection during antifungal prophylaxis (FLCZ/ITCZ capsules in 28, and newer mold-active agents in 53). Invasive aspergillosis (IA) was the most common, accounting for 67.9% (proven in 11, probable in 46), followed by invasive candidiasis (IC), (19.3%; candidemia in 15, encephalitis in 1). Although the incidences of IA and IC were comparable between CBT and uBMT patients, relatively rare type of IFIs caused by Trichosporon (4 cases), Mucor (2 cases) and Rodotorula (1 case) exclusively occurred in CBT patients, except one case of Fusarium infection in a patient who relapsed after uBMT. Grade II-IV acute GVHD, extensive chronic GVHD and systemic corticosteroids at ≥0.5mg/kg/day were identified as significant risk factors of IFIs for both groups (HR 1.89, P=0.01, HR 4.16, P=0.006, and HR 1.83, P=0.02). However, the impact of all these were not apparent in CBT patients (HR 1.59, P=0.16, HR 2.18, P=0.29 and HR 1.48, P=0.22), in contrast with the powerful impact in uBMT patients (HR 2.51, P=0.049, HR 10.23, P=0.03 and HR 2.87, P=0.03). Although the cessation of antifungal prophylaxis significantly increased the risk of IFIs in uBMT patients (HR 5.95, P=0.01), it showed no impact in CBT patients (HR 0.87, P=0.89). IFIs were main causes of death in 21 patients, which significantly affected non-relapse mortality in both CBT and uBMT patients (HR 3.93 and HR 6.08, both P<0.001). Conclusion Unrelated cord blood did not increase an overall incidence of IFIs, because higher risk in the early post-transplant period was counterbalanced by the dramatically decreased risk due to lower frequencies of GVHD and its treatment in the later period. Particular attention might be required to the early-onset IFIs due to fungi other than Aspergillus or Candida species, in order to further decrease the risk of IFIs after CBT. Disclosures: No relevant conflicts of interest to declare.

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