title: Results of an unrelated transplant search strategy using partially HLA-mismatched cord blood as an immediate alternative to HLA-matched bone marrow.
abstract: Cord blood (CB) is an alternative to other sources of stem cells for transplantation. However, the impact of including CB in the initial strategy of unrelated graft search in a cohort of patients has been the object of limited analysis. Here, we report the results of such a strategy in 91 consecutive children. Absence of mismatch was required for adult donors, and up to two mismatches were allowed for CB grafts, with a nucleated cell dose over 2.5 x 10(7) cells/kg. A graft was found for 84 of the 85 children who remained available for a 3-month search. In all, 64 patients were transplanted, 36 with CB and 28 with bone marrow (BM). Primary graft failure, acute grade II-IV and extensive chronic graft-versus-host disease occurred in five, five and zero CB, and in three, one and two BM patients, respectively. The 3-year survival was 59% in CB and 57% in BM patients. Accepting CB as a source of stem cells offers a graft to almost every child in need of an unrelated transplantation, with a probability of survival similar to that of unrelated BM transplantation.
authors.affiliation: 1Division of Hematology-Oncology, Hôpital Sainte-Justine, Montréal, Québec, Canada.
authors.forename: J H
authors.initials: JH
authors.lastname: Dalle
authors.forename: M
authors.initials: M
authors.lastname: Duval
authors.forename: A
authors.initials: A
authors.lastname: Moghrabi
authors.forename: E
authors.initials: E
authors.lastname: Wagner
authors.forename: M F
authors.initials: MF
authors.lastname: Vachon
authors.forename: S
authors.initials: S
authors.lastname: Barrette
authors.forename: M
authors.initials: M
authors.lastname: Bernstein
authors.forename: J
authors.initials: J
authors.lastname: Champagne
authors.forename: M
authors.initials: M
authors.lastname: David
authors.forename: J
authors.initials: J
authors.lastname: Demers
authors.forename: P
authors.initials: P
authors.lastname: Rousseau
authors.forename: R
authors.initials: R
authors.lastname: Winikoff
authors.forename: M A
authors.initials: MA
authors.lastname: Champagne
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001854:Bone Marrow Cells / Q000276:immunology*; D019583:Dose Fractionation, Radiation; D005312:Fetal Blood / Q000166:cytology* / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007938:Leukemia / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D008297:Male; D033581:Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D013234:Stem Cells / Q000166:cytology*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014916:Whole-Body Irradiation
chemical_list: D006680:HLA Antigens