title: Successful engraftment after reduced-intensity umbilical cord blood transplantation for adult patients with advanced hematological diseases.
abstract: OBJECTIVE
  The purpose of this research was to evaluate the feasibility of reduced-intensity unrelated cord-blood transplantation (RI-UCBT) in adult patients with advanced hematological diseases.
  
  
  METHODS
  Thirty patients (median age, 58.5 years; range, 20-70 years) with advanced hematological diseases underwent RI-UCBT at Toranomon Hospital between September 2002 and August 2003. Preparative regimen composed of fludarabine 25 mg/m(2) on days -7 to -3, melphalan 80 mg/m(2) on day -2, and 4 Gy total body irradiation on day -1. Graft-versus-host disease prophylaxis was composed of cyclosporin alone.
  
  
  RESULTS
  Twenty-six patients achieved primary neutrophil engraftment after a median of 17.5 days. Median infused total cell dose was 3.1 x 10(7)/kg (range, 2.0-4.3 x 10(7)/kg). Two transplant-related mortalities occurred within 28 days of transplant, and another 2 patients displayed primary graft failure. Cumulative incidence of complete donor chimerism at day 60 was 93%. Grade II-IV acute graft-versus-host disease occurred in 27% of patients, with median onset 36 days. Primary disease recurred in 3 patients, and transplant-related mortality within 100 days was 27%. Estimated 1-year overall survival was 32.7%. Excluding 7 patients with documented infection, 19 patients displayed noninfectious fever before engraftment (median onset, day 9). Manifestations included high-grade fever, eruption, and diarrhea. The symptoms responded well to corticosteroid treatments in 7 of 13 treated patients.
  
  
  CONCLUSIONS
  This study demonstrated the feasibility of RI-UCBT in adults.
authors.affiliation: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Shigesaburo
authors.initials: S
authors.lastname: Miyakoshi
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yuji
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kami
authors.forename: Eiji
authors.initials: E
authors.lastname: Kusumi
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Kishi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Naoko
authors.initials: N
authors.lastname: Murashige
authors.forename: Tamae
authors.initials: T
authors.lastname: Hamaki
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Kim
authors.forename: Jun-Ichi
authors.initials: J
authors.lastname: Ueyama
authors.forename: Shin-Ichiro
authors.initials: S
authors.lastname: Mori
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Morinaga
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Muto
authors.forename: Shigeru
authors.initials: S
authors.lastname: Masuo
authors.forename: Mineo
authors.initials: M
authors.lastname: Kanemaru
authors.forename: Tatsuyuki
authors.initials: T
authors.lastname: Hayashi
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takaue
authors.forename: Shuichi
authors.initials: S
authors.lastname: Taniguchi
mesh_terms: D000328:Adult; D000368:Aged; D001792:Blood Platelets / Q000166:cytology; D016572:Cyclosporine / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D005312:Fetal Blood / Q000166:cytology*; D006086:Graft vs Host Disease; D006402:Hematologic Diseases / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017404:In Situ Hybridization, Fluorescence; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D013997:Time Factors; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D014740:Vidarabine; C024352:fludarabine