scholarly journals Combined Haploidentical and Umbilical Cord Blood Allogeneic Stem Cell Transplantation for High-Risk Lymphoma and Chronic Lymphoblastic Leukemia

2018 ◽  
Vol 24 (2) ◽  
pp. 359-365 ◽  
Author(s):  
Jingmei Hsu ◽  
Andrew Artz ◽  
Sebastian A. Mayer ◽  
Danielle Guarner ◽  
Michael R. Bishop ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Stem Cell Transplantation ◽  
Cord Blood ◽  
Cell Transplantation ◽  
Umbilical Cord ◽  
Allogeneic Stem Cell Transplantation ◽  
Umbilical Cord Blood ◽  
Lymphoblastic Leukemia

Unrelated Donor Umbilical Cord Blood Transplantation (UD-UCBT) for Adult Patients with High-Risk Acute Myeloid Leukemia (AML)

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4401-4401
Author(s):  
Jai me Sanz ◽  
Silvana Saavedra ◽  
Pau Montesinos ◽  
Ignacio Lorenzo ◽  
Javier Palau ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Complete Remission ◽  
Stem Cell Transplantation ◽  
Cord Blood ◽  
Cell Transplantation ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Adult Patients ◽  
First Complete Remission

Abstract BACKGROUND: Adult patients with high-risk AML can benefit from allogeneic stem cell transplantation but most lack a suitable sibling or unrelated adult donor. Umbilical cord blood has emerged as an alternative source for stem cell transplantation. OBJECTIVES: The aim of the present study was to evaluate toxicity and efficacy of UD-UCBT for the treatment of high-risk AML in adults as well as to identify, by multivariate analysis, factors affecting transplant outcome. PATIENTS AND METHODS: Forty-four consecutive patients (27 males, 17 females) with a median age of 34 yr (range, 16–52) who underwent UD-UCBT at Hospital Universitario La Fe from 2000 until 2007 were analyzed. Primary high-risk feature was high risk cytogenetics (13), therapy-related AML (3) and two or more cycles to achieve first complete remission (CR1, 10) for patients transplanted in CR1 and salvage treatment for patients in second complete remission (CR2, 6) or more advanced stage of the disease (12). Five patients had failed a previous autologous stem cells transplant (ASCT). Conditioning regimen consisted of thiotepa, busulfan (oral, 8; IV, 36), cyclophosphamide (16) or fludarabine (28), and anti-thymocyte globulin. Cyclosporine and prednisone (37) or cyclosporine and mycophenolate mofetil (7) were used for graft-versus-host disease (GVHD) prophylaxis. Most patients (93%) received an HLA-mismatched cord blood unit with 1 (43%) or 2 (50%) disparities. The median number of total nucleated cells (TNC) and CD34+ cells infused was 2 ×107/kg (range, 1–4.4) and 1.2 ×105/kg (range, 0.1–6), respectively. RESULTS: Cumulative incidence (CI) of myeloid and platelet engraftment was 98% and 72% at a median time of 20 and 54 days respectively. Higher CFU-GM counts at infusion accelerated neutrophil recovery and higher CD34+ cell dose at infusion as well as being in first complete remission (CR1) improved platelet engraftment. CI of acute GVHD grades II–IV and III–IV was 20% and 9%, respectively. CI of chronic and chronic extensive GVHD was 47% and 21%, respectively. CI of non-relapse mortality at 2 years was 38% and was significantly increased in patients transplanted beyond CR1 (53% vs 29%; p = 0.01). With a median follow-up of 19 months (range, 7–75), CI of relapse was 20% at 2 years and was higher in patients beyond CR1 (35% vs 18%; p = 0.02) and in patients receiving a lower TNC dose (39% vs 9%; p = 0.02). Event-free survival (EFS) at 2 years was 42% and was significantly higher for patients in CR1 (53% vs 19%; p < 0.01). CONCLUSIONS: These results show that UD-CBT is a curative alternative for a significant number of patients with high-risk AML. This option should be offered to patients early in the course of their disease to improve outcomes. Apart from disease status, cord blood cell dose affected engraftment and could also influence relapse incidence.

Unrelated Donor Umbilical Cord Blood Transplantation (UD-UCBT) for Adult Patients with High-Risk Acute Lymphoblastic Leukemia (ALL).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2024-2024
Author(s):  
Jaime Sanz ◽  
Ignacio Lorenzo ◽  
Pau Montesinos ◽  
Leonor Senent ◽  
Luis Larrea ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Stem Cell Transplantation ◽  
Cord Blood ◽  
Cell Transplantation ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Acute Gvhd ◽  
Adult Patients ◽  
Number Of Patients

Abstract BACKGROUND: Adult patients with high-risk ALL can benefit from allogeneic stem cell transplantation but most lack a suitable sibling or unrelated adult donor. Umbilical cord blood has emerged as an alternative source for stem cell transplantation. OBJECTIVES: The aim of the present study was to evaluate toxicity and efficacy of UD-UCBT for the treatment of high-risk ALL in adults as well as to identify by multivariate analysis factors affecting transplant outcome. PATIENTS AND METHODS: Thirty-seven consecutive patients (23 males, 14 females) with median age 26 yr (range, 15–47) who underwent UD-UCBT at a single institution from 1999 until 2006 were analyzed. Primary high-risk feature was Philadelphia-positive ALL (12), MLL rearrangement (3), primary refractory disease (3), salvage treatment for patients in second complete remission (CR2, 4) or beyond CR2 (6), and slow response to initial therapy or 2 cycles to achieve CR (9). Conditioning regimen consisted of thiotepa, busulfan (oral, 13; IV, 24), cyclophosphamide (24) or fludarabine (13), and anti-thimocyte globulin. Cyclosporine and prednisone were used for graft-versus-host disease (GVHD) prophylaxis. Most patients (95%) received an HLA-mismatched cord blood unit with 1 (35%) or 2 (60%) HLA disparities. At infusion, the median number of nucleated cells and CD34+ cells was 2.4 × 107/kg and 1.3 × 105/kg, respectively. RESULTS: Cumulative incidence (CI) of myeloid and platelet engraftment was 92% and 76% at a median time of 21 and 63 days respectively. CI of GVHD acute grades II-IV, III-IV and chronic extensive was 29%, 19% and 19% respectively. Transplant-related mortality at 180 days was 29% and was significantly increased in patients developing severe acute GVHD (96% vs 19%; p < 0.001). With a median follow-up of 23 months (range, 7–88), CI of relapse was 34% at 3 years and was higher in patients beyond CR1 (63% vs 28%; p < 0.001). 3-year event-free survival (EFS) and overall survival (OS) were 33% and 37%, respectively. Patients in CR1/2 had better EFS (41% vs 14%; p = 0.04) and OS (50% vs 14%; p = 0.04) while those who developed severe acute GVHD had a worse EFS (42% vs 0%; p = 0.004) and OS (49% vs 0%; p = 0.004). CONCLUSIONS: These results show that UD-CBT is a curative alternative for a significant number of patients with high-risk ALL. This option should be offered to patients early in the course of their disease to improve outcomes.

scholarly journals Long-Lasting HHV-6 Reactivation in Long-Term Adult Survivors After Double Umbilical Cord Blood Allogeneic Stem Cell Transplantation

2014 ◽  
Vol 210 (4) ◽  
pp. 567-570 ◽  
Author(s):  
Marina Illiaquer ◽  
Florent Malard ◽  
Thierry Guillaume ◽  
Berthe-Marie Imbert-Marcille ◽  
Jacques Delaunay ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cord Blood ◽  
Cell Transplantation ◽  
Umbilical Cord ◽  
Allogeneic Stem Cell Transplantation ◽  
Umbilical Cord Blood ◽  
Adult Survivors

scholarly journals Umbilical Cord Blood as an Alternate Donor Sources for High Risk Elderly Patients Undergoing Allogeneic Stem Cell Transplantation for Hematological Malignancies

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Patrick Hagen ◽  
◽  
William Adams ◽  
Shruti Singh ◽  
Shuai Qin ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Stem Cell Transplantation ◽  
Elderly Patients ◽  
Cord Blood ◽  
Umbilical Cord ◽  
Allogeneic Stem Cell Transplantation ◽  
Umbilical Cord Blood ◽  
Hematological Malignancies ◽  
Donor Source

Allogeneic stem cell transplantation remains the only curative option for many hematological malignancies. Umbilical cord blood (UCB) is an alternate donor source with potentially increased morbidity in elderly patients. We evaluated outcomes in alternate donor sources, prior to the initiation of haploidentical transplantation at our institution, of matched unrelated donor (MUD) and UCB in elderly patients (mean age 64, range 60-75). One hundred and eighty-four patients were included (MRD: 57; MUD: 69; UCB: 58). There was no difference in acute or chronic graft versus host disease among donor sources (all p > .05). In this high-risk population, 128 (70%) had either a high disease risk index or high (>2) comorbidity index. Median progression free survival (PFS) was lowest among UCB (5.5 months; 95% CI 2.8-9.4) and MUD (5.6 months; 95% CI 3.7-17.7) as compared to MRD (18.3 months; 95% CI 8.4-64.8). On multivariable analysis, the rate of mortality was higher for UCB than MRD patients (1.88, 95% CI 1.04 – 3.37), but there was no difference between UCB and MUD (p = .61) or between MUD and MRD (p = .25). Conclusions were similar for PFS. Our experience shows that even in this high-risk elderly cohort, UCB continues to be a viable alternate donor source.

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