title: Successful engraftment of mismatched unrelated cord blood transplantation following reduced intensity preparative regimen using fludarabine and busulfan.
abstract: We conducted a pilot study to evaluate the feasibility of reduced-intensity cord blood transplantation (RI-CBT) using a non-total body irradiation (TBI) regimen in adult patients with advanced hematologic malignancies. Seventeen patients with a median age of 58 years (range, 38-74) underwent RI-CBT at Tsukuba Memorial Hospital between April 2004 and November 2005. Preparative regimens were fludarabine 30 mg/m(2) for 6 days, and busulfan 4 mg/kg for 2 days. Tacrolimus was used for prophylaxis of graft-vs-host disease (GVHD). Median numbers of infused total nucleated were 2.6 x 10(7)/kg (range, 2.0-3.3). HLA disparity was found in 2/6 antigens (n=16) and 1/6 antigens (n=1). Underlying diseases progressed despite preparative regimens in four patients. Of the remaining 13 patients, nine patients achieved engraftment at a median of day 18 (range, 17-28). Six of the nine patients with engraftment achieved complete donor-type chimerism by day 100. Six patients were alive in remission at median follow-up of 13.1 months (range, 1.0-19.0). This study demonstrated the feasibility of RI-CBT using a non-TBI regimen in adults. When disease progression is controlled by the preparative regimen, RI-CBT carries a clinically significant graft-vs-tumor effect. Further studies are required to identify patients who benefit from this regimen.
authors.affiliation: Department of Hematology, Tsukuba Memorial Hospital, Tsukuba, Japan.
authors.forename: Tsunehiko
authors.initials: T
authors.lastname: Komatsu
authors.forename: Hiroto
authors.initials: H
authors.lastname: Narimatsu
authors.forename: Ai
authors.initials: A
authors.lastname: Yoshimi
authors.forename: Naoki
authors.initials: N
authors.lastname: Kurita
authors.forename: Manabu
authors.initials: M
authors.lastname: Kusakabe
authors.forename: Akiko
authors.initials: A
authors.lastname: Hori
authors.forename: Naoko
authors.initials: N
authors.lastname: Murashige
authors.forename: Tomoko
authors.initials: T
authors.lastname: Matsumura
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yuji
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kami
mesh_terms: D000328:Adult; D000368:Aged; D002066:Busulfan / Q000008:administration & dosage*; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D004359:Drug Therapy, Combination; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage; D010865:Pilot Projects; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014916:Whole-Body Irradiation
chemical_list: D019653:Myeloablative Agonists; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine