scholarly journals Unrelated cord blood transplantation for newly diagnosed patients with severe acquired aplastic anemia using a reduced-intensity conditioning: high graft rejection, but good survival

2012 ◽  
Vol 47 (9) ◽  
pp. 1186-1190 ◽  
Author(s):  
H-L Liu ◽  
Z-M Sun ◽  
L-Q Geng ◽  
X-B Wang ◽  
K-Y Ding ◽  
...  
Keyword(s):  
Cord Blood ◽  
Aplastic Anemia ◽  
Graft Rejection ◽  
Cord Blood Transplantation ◽  
Good Survival ◽  
Newly Diagnosed ◽  
Reduced Intensity Conditioning ◽  
Blood Transplantation ◽  
Unrelated Cord Blood ◽  
Reduced Intensity

Unrelated Cord Blood Transplantation for Severe Acquired Aplastic Anemia Using a Reduced-Intensity Conditioning: High Graft Rejection but Good Survival

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2368-2368
Author(s):  
Huilan Liu ◽  
Liangquan Geng ◽  
Xingbing Wang ◽  
Kaiyang Ding ◽  
Baolin Tang ◽  
...  
Keyword(s):  
Cord Blood ◽  
Total Dose ◽  
Aplastic Anemia ◽  
Graft Rejection ◽  
Research Funding ◽  
Cord Blood Transplantation ◽  
Unrelated Cord Blood Transplantation ◽  
Blood Transplantation ◽  
Unrelated Cord Blood ◽  
Reduced Intensity

Abstract Abstract 2368 We report a single center experience in treating 16 consecutive patients (nine male and seven female) with severe aplastic anemia (AA) who received unrelated cord blood transplantation (UCBT) between 2006 and 2010. The main outcomes of interest were the tolerability and toxicity of UCBT, hematopoietic reconstitution and survival. The first two patients using a conditioning regimen consisting of cyclophosphamide (total dose 120°<<200 mg/kg), rabbit anti-thymocyte globulin (ATG, total dose 10°<<15 mg/kg) and methylprednisolone (total dose 1.5g). The other 14 cases received a reduced-intensity regimen composed of cyclophosphamide (total dose1200mg/©O), ATG (total dose 30 mg/kg) and fludarabine (total dose 120°<<180 mg/m2). Cyclosporine and mycophenolate mofetil were used as GVHD prophylaxis. The median age was 17 years (range 5–61 years) and the median weight was 48 kg (range 16–65 kg). Ten of sixteen were very SAA (VSAA). The median interval between diagnosis and UCBT was 30 days (range, 15–180). All except one did not received ATG-based immunosuppressive therapy before UCBT. Twelve patients received single UCB unit, four cases received double units. Donor/recipient HLA was at least four of six loci matching. The median nucleated cell dose infused was 4.27×107 cells/kg (range 2.34–13.41×107 cells/kg) and CD34+ cell dose infused was 2.02×105 cells/kg (range 0.71–4.35×105 cells/kg). Two patients were not evaluable for engraftment because of early death on day +21 and +22 due to severe infection and intracranial hemorrhages, respectively. Only one of the fourteen cases had engraftment with complete chimerism of single UCB unit from day 7, whose ANC© f 0.5 ×109/L and platelet© f20 ×109/L occurred on day 12 and day 31 post double UCBT, respectively. But she experienced secondary graft failure after three months post transplantation and attained survival by successful haplo-identical related transplantation. Thirteen patients experienced primary graft rejection, but all of them acquired autologous recovery. The 3-month and 6-month cumulative incidence of response was 61.5% and 85.7%, respectively. Currently, 14 patients are alive, having survived for 189 to 1712 days (median, 544 days) after their transplantations. The probability of overall survival at 4 years was 87.5%.Our data indicate that UCBT for new diagnosed SAA using no irradiation but fludarabine-based conditioning still seems to be inevitable to led to the high risk of rejection, but may facilitate autologous recovery and improve survival with low risk of transplant-related mortality. Disclosures: Sun: Fund of 11th Five-Year Science and Technology Key Project of Anhui Province (06013128B): Research Funding; Fund of Anhui Provincial “115” Industrial Innovation Program: Research Funding.

Reduced Intensity Conditioning Regimen in Single Unrelated Cord Blood Transplantation in Adults with Hematological Malignant Disorders. An Eurocord-Netcord and SFGM-TC Survey.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3143-3143 ◽  
Author(s):  
Vanderson Rocha ◽  
Bernard Rio ◽  
Federico Garnier ◽  
Marc Renaud ◽  
Anne Sirvent ◽  
...  
Keyword(s):  
Cord Blood ◽  
Cord Blood Transplantation ◽  
Conditioning Regimen ◽  
Reduced Intensity Conditioning ◽  
Blood Transplantation ◽  
Reduced Intensity Conditioning Regimen ◽  
Conditioning Regimens ◽  
Unrelated Cord Blood ◽  
One Year ◽  
Reduced Intensity

Abstract Results of reduced intensity conditioning regimen (RIC) in unrelated cord blood transplantation (UCBT) have been reported, however more frequently RIC was performed using double cord blood transplants. In order to study risk factors in single RIC-UCBT we have analyzed 65 patients with hematological malignancies (ALL=10, AML=37, Hodking and NHL=10, MDS=4, CML=3, Myeloma =1) transplanted from 1999–2005 and reported to Eurocord and SFGM-TC. The median follow-up was 8 months (3–26) and the median age was 47 years (16–76). At transplant, 49% of the patients had advanced phase of disease and 39% had received a previous autologous transplants. The conditioning regimen varied according diasease and centers: Fludarabine(FLU)+Endoxan (EDX) +TBI (2Gy) was given to 33 patients, FLU+(EDX or Melphalan) in 11, FLU+BU (<8mg/kg) associated or not to other drugs in 13, FLU+TBI(2GY) in 3 and other regimens in 5 patients. ATG/ALG was added in 26% of the cases. GVHD prophylaxis most commonly (55%) consisted of CsA and MMF; 87% received hematopoietic growth factors (<day 8). The median nucleated cell dose infused was 2.4 x107/kg and the graft was HLA identical (6/6) ( HLA A and B low resolution and DRB1 allelic typing) in 3 cases, 5/6 in 15, 4/6 in 37 and 3/6 in 10. Results: Median time to neutrophil recovery (>500/mm3) was 20 days (0–56) and 35 dyas for platelets recovery (>20.000/mm3). At day 60 probability of neutrophil recovery was 87± 7% of the 33 patients who received the Flu+End+TBI conditioning regimen and was 65±10% for patients receiving other regimens (p<0.01). Chimerism analysis was available in 71% of the patients at 3 months and was full donor in 67%, mixed chimerism in 9% and autologous reconstitution in 24%. Grade II aGVHD was observed in 13%, grade III in 7% and grade IV in 7%; the TRM was 45±7% overall, 50±15% in acute leukemia, 30±15% in lymphomas and 27±16% for other diagnoses. The TRM at one year for those receiving <2.4 x 107 TNC/kg was 53±9% and for those receiving >2.4 x107TNC/kg was 39±10% (p=0.07). For patients receiving Flu+End+TBI the TRM at one year was 24±10% and for those receiving other conditioning regimens was 60±9% (p=0.001). DFS at one year for lymphomas was 50±9%, for leukemias was 27±7% and for other diagnoses was zero. When the HLA compatibility was 6/6 or 5/6, DFS at one year was 42±12%, for 4/6 disparities DFS was 27±9% and for 3/6 disparities DFS was zero. DFS was 43±11% for those receiving Flu+End+TBI, and was 16±7% for patients receiving other conditioning regimens (p=0.005). For patients receiving >2.4 x 107TNC/kg the DFS was 31±12% and for patients receiving <2.4 x 107TNC/kg the DFS was 14±8% (p=0.05). In collusion, results of single RIC-UCBT are encouraging; cell dose and HLA remain important factors in this setting. The type of conditioning (Flu+End+TBI) seems to be associated with decreased TRM and better DFS, but a multivariate analysis with a higher number of patients is needed.

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