title: Hematopoietic engraftment and survival in adult recipients of umbilical-cord blood from unrelated donors.
abstract: BACKGROUND
  Umbilical-cord blood from unrelated donors who are not HLA-identical with the recipients can restore hematopoiesis after myeloablative therapy in children. We studied the use of transplantation of umbilical-cord blood to restore hematopoiesis in adults.
  
  
  METHODS
  Sixty-eight adults with life-threatening hematologic disorders received intensive chemotherapy or total-body irradiation and then transplants of HLA-mismatched umbilical-cord blood. We evaluated the outcomes in terms of hematologic reconstitution, the occurrence of acute and chronic graft-versus-host disease (GVHD), relapses, and event-free survival.
  
  
  RESULTS
  Of the 68 patients, 48 (71 percent) received grafts of umbilical-cord blood that were mismatched for two or more HLA antigens. Of the 60 patients who survived 28 days or more after transplantation, 55 had neutrophil engraftment at a median of 27 days (range, 13 to 59). The estimated probability of neutrophil recovery in the 68 patients was 0.90 (95 percent confidence interval, 0.85 to 1.0). The presence of a relatively high number of nucleated cells in the umbilical-cord blood before it was frozen was associated with faster recovery of neutrophils. Severe acute GVHD (of grade III or IV) occurred in 11 of 55 patients who could be evaluated within the first 100 days after transplantation. Chronic GVHD developed in 12 of 33 patients who survived for more than 100 days after transplantation. The median follow-up for survivors was 22 months (range, 11 to 51). Of the 68 patients, 19 were alive and 18 of these (26 percent) were disease-free 40 months after transplantation. The presence of a high number of CD34+ cells in the graft was associated with improved event-free survival (P=0.05).
  
  
  CONCLUSIONS
  Umbilical-cord blood from unrelated donors can restore hematopoiesis in adults who receive myeloablative therapy and is associated with acceptable rates of severe acute and chronic GVHD.
authors.affiliation: Department of Medicine, Ireland Cancer Center at University Hospitals of Cleveland and Case Western Reserve University, OH 44106-5065, USA. mjl13@po.cwru.edu
authors.forename: M J
authors.initials: MJ
authors.lastname: Laughlin
authors.forename: J
authors.initials: J
authors.lastname: Barker
authors.forename: B
authors.initials: B
authors.lastname: Bambach
authors.forename: O N
authors.initials: ON
authors.lastname: Koc
authors.forename: D A
authors.initials: DA
authors.lastname: Rizzieri
authors.forename: J E
authors.initials: JE
authors.lastname: Wagner
authors.forename: S L
authors.initials: SL
authors.lastname: Gerson
authors.forename: H M
authors.initials: HM
authors.lastname: Lazarus
authors.forename: M
authors.initials: M
authors.lastname: Cairo
authors.forename: C E
authors.initials: CE
authors.lastname: Stevens
authors.forename: P
authors.initials: P
authors.lastname: Rubinstein
authors.forename: J
authors.initials: J
authors.lastname: Kurtzberg
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D018952:Antigens, CD34; D002908:Chronic Disease; D018572:Disease-Free Survival; D005312:Fetal Blood / Q000276:immunology; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000145:classification / Q000453:epidemiology; D006402:Hematologic Diseases / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D007958:Leukocyte Count; D008875:Middle Aged; D009504:Neutrophils; D012008:Recurrence; D019172:Transplantation Conditioning
chemical_list: D018952:Antigens, CD34