Results of unrelated cord blood transplant in fanconi anemia patients: risk factor analysis for engraftment and survival.
We retrospectively analyzed results of unrelated cord blood transplantation (UCBT) in 93 Fanconi anemia (FA) patients. Median age at transplantation was 8.6 years (1-45). The units transplanted were HLA-A, -B, or -DRB1 identical in 12 cases, 1 HLA mismatch in 35 cases, and 2 or 3 HLA differences in 45 cases. The median number of nucleated cells (NC) and CD34+ cells infused of recipient weight was 4.9x10(7)/kg and 1.9x10(5)/kg, respectively. Participating centers selected the preparative regimen of their choice, in 57 patients (61%), it included Fludarabine. Graft-versus-host disease (GVHD) prophylaxis consisted mostly of cyclosporine with prednisone. Cumulative incidence (CI) of neutrophil recovery was 60+/-5% at day +60. In multivariate analysis, Fludarabine containing regimen and NC infused>or=4.9x10(7)/kg were associated with higher probability of recovery. CI of grade II-IV acute and of chronic GVHD (aGVHD, cGVHD) was 32%+/-5% and 16%+/-4%, respectively. Overall survival (OS) was 40%+/-5%. In multivariate analysis, factors associated with favorable outcome were use of Fludarabine in the conditioning regimen, number of NC infused>or=4.9x10(7)/kg, and negative cytomegalovirus (CMV) serology in the recipient. In conclusion, factors easily modifiable such as donor selection and a Fludarabine-containing regimen can considerably improve survival in FA patients given a UCBT. These data are the basis for designing prospective protocols.
Gluckman
Eliane
E
Hôpital Saint Louis AP/HP, University of Paris VII, IUH, Paris, France. eliane.gluckman@sls.aphp.fr
Rocha
Vanderson
V
Ionescu
Irina
I
Bierings
Marc
M
Harris
Richard E
RE
Wagner
John
J
Kurtzberg
Joanne
J
Champagne
Martin A
MA
Bonfim
Carmem
C
Bittencourt
Marco
M
Darbyshire
Philip
P
Fernandez
Manuél-Nicolas
MN
Locatelli
Franco
F
Pasquini
Ricardo
R
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D005199:Fanconi Anemia / Q000401:mortality / Q000628:therapy*; D005260:Female; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use
D014740:Vidarabine; C024352:fludarabine