scholarly journals Optimization of Unrelated Donor Cord Blood Transplantation for Thalassemia: Implications for Other Non‐Malignant Indications such as HIV Infection or Autoimmune Diseases

10.5772/66190 ◽  
2017 ◽  
Author(s):  
Christine Chow ◽  
Tracie Dang ◽  
Vincent Guo ◽  
Michelle Chow ◽  
Qingyu Li ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Autoimmune Diseases ◽  
Cord Blood ◽  
Cord Blood Transplantation ◽  
Unrelated Donor ◽  
Blood Transplantation

scholarly journals INFECTIOUS COMPLICATIONS AFTER UMBILICAL CORD-BLOOD TRANSPLANTATION FROM UNRELATED DONORS

2016 ◽  
Vol 8 ◽  
pp. 2016051 ◽  
Author(s):  
Juan Montoro ◽  
Jaime Sanz
Keyword(s):  
Stem Cell ◽  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Cord Blood Transplantation ◽  
Infectious Complications ◽  
Unrelated Donor ◽  
Alternative Source ◽  
Hematopoietic Stem ◽  
Blood Transplantation

Umbilical cord-blood (UCB) is a well-recognized alternative source of stem cells for unrelated donor hematopoietic stem cell transplantation (HSCT). As compared with other stem cell sources from adult donors, it has the advantages of immediate availability of cells, absence of risk to the donor and reduced risk of graft-versus-host disease despite donor-recipient HLA disparity. However, the use of UCB is limited by the delayed post-transplant hematologic recovery due, at least in part, to the reduced number of hematopoietic cells in the graft and the delayed or incomplete immune reconstitution. As a result, severe infectious complications continue to be a leading cause of morbidity and mortality following UCB transplantation (UCBT). We will address the complex differences in the immune properties of UCB and review the incidence, characteristics, risk factors, and severity of bacterial, fungal and viral infectious complications in patients undergoing UCBT.

scholarly journals Early infections in adult patients undergoing unrelated donor cord blood transplantation

2002 ◽  
Vol 30 (12) ◽  
pp. 937-943 ◽  
Author(s):  
S Saavedra ◽  
GF Sanz ◽  
I Jarque ◽  
F Moscardó ◽  
C Jiménez ◽  
...  
Keyword(s):  
Cord Blood ◽  
Cord Blood Transplantation ◽  
Adult Patients ◽  
Unrelated Donor ◽  
Blood Transplantation

Double-Unit Cord Blood Transplantation in Japan.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5166-5166 ◽  
Author(s):  
Shunro Kai ◽  
Mahito Misawa ◽  
Tohru Iseki ◽  
Satoshi Takahashi ◽  
Kenji Kishi ◽  
...  
Keyword(s):  
Cord Blood ◽  
Median Time ◽  
Hematological Malignancies ◽  
Cord Blood Transplantation ◽  
Unrelated Donor ◽  
Hematopoietic Stem ◽  
Cell Dose ◽  
Blood Transplantation ◽  
Single Donor ◽  
Cord Blood Unit

Abstract Cord blood (CB) is being increasingly used as a source of hematopoietic stem cells for patients in need of stem cell transplantation when a HLA matched-related or unrelated donor is not found. However, cord blood transplantation (CBT) in adults is limited by its lower cell dose. We have started investigating whether transplant with two units of CB will make an engraftment faster and improve outcomes in adult patient lacking a suitable single CB unit. Four transplant centers have participated in this clinical study. Eligibility for this study are as follows; 1) high-risk or advanced hematological malignancy without a related donor, 2) no HLA-matched unrelated BM donor in JMDP or requirement for urgent transplantation, and 3) absence of single HLA 0–2 antigen-mismatched cord blood unit with a cell dose of >2.5x10e7/kg. Eleven patients with hematological malignancies (AML 7, MLL 2, ALL 1, LBL 1) were transplanted with two CB units, following myeloablative conditioning with fractionated TBI(12Gy)+ G-CSF (5?g/kg/dx2days) combined ara-C (12g/?) +CY (120mg/kg) or TBI(12Gy) + CY (120mg/kg). GVHD prophylaxis consisted of short term MTX and CSA. The median age was 33 years (range; 19–52) and median weight was 68kg (range 48– 84). CB grafts were HLA 0–2 antigen-mismatched to the patients and each other, with a median total cryopreserved cell dose of 3.88x10e7/kg (range; 2.83–4.79) and median CD34+ cell dose of 1.06x10e5/kg (0.62–2.6). Nine out of 11 patients engrafted successfully, and had 96–100% single donor chimerism at day+28 bone marrow aspirate. The median time to neutrophil engraftment (ANC >500 /?) was 21days (16–26) and median time to platelets >50000 /?was 53 days (32–98). Nine patients who survived more than 28 days had AGVHD (grade I in 2, II in 3, III in 1), and CGVHD (limited type) was developed in 4 of the 6 evaluable patients. Two patients died of sepsis at day 7 and 27 and one had relapse at day 249. Nine patients are now alive 3 to 16 months after CBT. These preliminary results suggest that multiple unit CBT seems to be useful for adult with hematological malignancies lacking an appropriate BM donor or a single CB unit. Further studies with double-unit CBT may be warranted.

High Rate of Engraftment and Low Regimen-Related Toxicity Using Fludarabine, Melphalan and Thiotepa Conditioning for Unrelated Donor Cord Blood Transplantation

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4414-4414
Author(s):  
Stefan O Ciurea ◽  
Partow Kebriaei ◽  
Issa F Khouri ◽  
Muzaffar H. Qazilbash ◽  
Roy B Jones ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Cord Blood ◽  
Cord Blood Transplantation ◽  
Conditioning Regimen ◽  
Hematologic Malignancies ◽  
Adult Patients ◽  
High Rate ◽  
Unrelated Donor ◽  
Platelet Recovery ◽  
Blood Transplantation

Abstract BACKGROUND: Cord blood transplantation (CBT) represents an alternative source of stem cells for adult patients who lack a matched sibling or unrelated donor. However, the optimal type and intensity of the preparative regimen for patients receiving a CBT is not clear. We hypothesized that a conditioning regimen consisting of fludarabine, melphalan and thiotepa will be associated with an acceptable rate of engraftment and treatmentrelated mortality in patients receiving a CBT. METHODS: 37 patients, median age 31 years (2–57) and a median weight of 73kg, were treated between 8/2003 and 5/2008. All had advanced hematologic malignancies (24 with acute leukemia, 12 with lymphoma and one with CLL) At the time of transplant, 21 pts (57%) were in complete remission (CR) (first CR=20%) and 16 had relapsed/refractory disease. Grafts consisted of double (29 pts) or single (8 pts) CB units. Cytogenetics for patients with acute leukemia were poor in 11, intermediate in 9, good in 1 and unknown in 3 pts. Donor recipient HLA matching was (intermediate resolution class I HLA A and B and high-resolution DRB1): 3/6 (n=1, 1.5%), 4/6 (n=47, 71.2%) and 5/6 (n=18, 27.3%) alleles (n=66 units). Median total nucleated cell count was 1.8×107/kg (range 1–5.8). Nineteen patients received ex-vivo expanded units. The conditioning regimen consisted of melphalan 140 mg/m2 on day -8, thiotepa 10 mg/m2 on day -7, fludarabine 160 mg/m2 over 4 days on days -6, -5, -4, -3, and rabbit ATG 1.25 mg/kg on day -4 and 1.75 mg/kg on day -3 (FMT). Patients with CD 20+ lymphoid malignancies also received rituximab 375mg/m2 on day -9 (n=8, 22%). GVHD prophylaxis was tacrolimus and mini-methotrexate in 23 (62%) and tacrolimus and mycophenolate in 14 pts (38%). RESULTS: 36 patients (97%) were evaluable for engraftment. 1 patient died within 30 days due to progressive leukemia. 34/36 patients (95%) engrafted neutrophils and had hematopoietic recovery with 100% cord blood-derived cells. At day 30, of the 29 patients who received a double CBT, 75% had chimerism derived entirely from one donor while 25% had mixed donors chimerism. Neutrophil recovery to ANC >0.5 × 10e9/l occurred after a median of 21 days (range 6–45) and platelet recovery to >20 × 10e9/l after a median of 37 days (range 26–134, N=24; 67%). 32/37 pts (87%) were in CR after transplant with 16 surviving after a median follow-up of 12.1 months. Thirteen patients (36%) developed gr II–IV aGVHD (gr III–IV aGVHD in 5 patients, 14%), and 13 of 32 patients had cGVHD (40%), with the majority experiencing extensive GVHD. 11 patients (29.7%) relapsed after a median of 7 months post transplant and 12 died of nonrelapse causes. Day-100 treatment-related mortality in this heavily pre-treated population was 10%. Overall, causes of death included disease relapse (n=9), infections (n=6), organ failure (n=3), pulmonary hemorrhage (n=1) and GVHD (n=2). CONCLUSIONS: The FMT regimen was sufficiently immunosuppressive to support high rate of engraftment with acceptable TRM in heavily pre-treated adult patients with advanced hematologic malignancies undergoing CBT. These results support further evaluation of this regimen in CBT.

scholarly journals Optimal Practices in Unrelated Donor Cord Blood Transplantation for Hematologic Malignancies

2017 ◽  
Vol 23 (6) ◽  
pp. 882-896 ◽  
Author(s):  
Juliet N. Barker ◽  
Joanne Kurtzberg ◽  
Karen Ballen ◽  
Michael Boo ◽  
Claudio Brunstein ◽  
...  
Keyword(s):  
Cord Blood ◽  
Cord Blood Transplantation ◽  
Hematologic Malignancies ◽  
Unrelated Donor ◽  
Blood Transplantation
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