Successful engraftment after reduced-intensity umbilical cord blood transplantation for adult patients with advanced hematological diseases.
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.
Miyakoshi
Shigesaburo
S
Department of Hematology, Toranomon Hospital, Tokyo, Japan.
Yuji
Koichiro
K
Kami
Masahiro
M
Kusumi
Eiji
E
Kishi
Yukiko
Y
Kobayashi
Kazuhiko
K
Murashige
Naoko
N
Hamaki
Tamae
T
Kim
Sung-Won
SW
Ueyama
Jun-Ichi
J
Mori
Shin-Ichiro
S
Morinaga
Shin-ichi
S
Muto
Yoshitomo
Y
Masuo
Shigeru
S
Kanemaru
Mineo
M
Hayashi
Tatsuyuki
T
Takaue
Yoichi
Y
Taniguchi
Shuichi
S
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
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D014740:Vidarabine; C024352:fludarabine