Results of an unrelated transplant search strategy using partially HLA-mismatched cord blood as an immediate alternative to HLA-matched bone marrow.
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.
Dalle
J H
JH
1Division of Hematology-Oncology, Hôpital Sainte-Justine, Montréal, Québec, Canada.
Duval
M
M
Moghrabi
A
A
Wagner
E
E
Vachon
M F
MF
Barrette
S
S
Bernstein
M
M
Champagne
J
J
David
M
M
Demers
J
J
Rousseau
P
P
Winikoff
R
R
Champagne
M A
MA
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
D006680:HLA Antigens