title: Outcomes of unrelated cord blood transplantation in pediatric recipients.
abstract: We report results of unrelated cord blood transplants (UCBT) in 29 pediatric recipients in one center and the risk factors associated with survival. Median age: 9 years (0.5-20); diagnosis: ALL (9), AML (4), CML (1), HD (3), HLH (1), NHL (3), NBL (2); B-thal (1), FA (1), FEL (1), Krabbe (1), WAS (1), SAA (1); median follow-up: 11 months; conditioning: total body irradiation (TBI)-ablative (14), chemotherapy-ablative (6) and reduced intensity chemotherapy (9); GVHD prophylaxis: MMF/FK506 (18), cyclosporin A (CsA)+steroids+/-MMF (7) or CsA+methotrexate (MTX) (4); median total nucleated cells (TNC): 3.8 x 10(7)/kg (1.1-11); median CD34+: 2.3 x 10(5)/kg (0.2-9.9); and HLA match: 2 (6/6), 5 (5/6), 22 (4/6). Neutrophil engraftment by cumulative incidence curves 63% (median 28 (95% confidence interval (CI) 18-32)). Probability of >/=grade II acute graft-versus-host disease (aGVHD) by day +60 27%, >/=grade III aGVHD 20% and chronic graft-versus-host disease 3%. Estimated 1-year overall survival (OS) 46% (95% CI 30-71) and standard risk 60% (95% CI 29-100%). Variables associated with improved survival by multivariate analysis include non-TBI-ablative conditioning (P=0.024), CD34+/kg (P=0.038) and gender (P=0.048). These results suggest that CD34/kg cell dose and non-TBI-ablative conditioning may be important variables influencing OS following UCBT in pediatric recipients. Given the small number of patients, these results should be viewed cautiously.
authors.affiliation: Department of Pediatrics, Children's Hospital of New York-Presbyterian, Herbert Irving Comprehensive Cancer Center, NY 10032, USA.
authors.forename: J
authors.initials: J
authors.lastname: Styczynski
authors.forename: Y-K
authors.initials: YK
authors.lastname: Cheung
authors.forename: J
authors.initials: J
authors.lastname: Garvin
authors.forename: D G
authors.initials: DG
authors.lastname: Savage
authors.forename: G B
authors.initials: GB
authors.lastname: Billote
authors.forename: L
authors.initials: L
authors.lastname: Harrison
authors.forename: D
authors.initials: D
authors.lastname: Skerrett
authors.forename: K
authors.initials: K
authors.lastname: Wolownik
authors.forename: C
authors.initials: C
authors.lastname: Wischhover
authors.forename: R
authors.initials: R
authors.lastname: Hawks
authors.forename: M B
authors.initials: MB
authors.lastname: Bradley
authors.forename: G
authors.initials: G
authors.lastname: Del Toro
authors.forename: D
authors.initials: D
authors.lastname: George
authors.forename: D
authors.initials: D
authors.lastname: Yamashiro
authors.forename: C
authors.initials: C
authors.lastname: van de Ven
authors.forename: M S
authors.initials: MS
authors.lastname: Cairo
mesh_terms: D000293:Adolescent; D000328:Adult; D018952:Antigens, CD34 / Q000032:analysis; D001782:Blood Donors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D008297:Male; D011336:Probability; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D018952:Antigens, CD34