title: Unrelated umbilical cord blood transplantation using a TBI/FLAG conditioning regimen for adults with hematologic malignancies.
abstract: A combined chemotherapy regimen comprising fludarabine, cytosine arabinoside, and granulocyte colony-stimulating factor (FLAG) has been used in the treatment of relapsed or refractory leukemias. We here report 38 patients with hematologic malignancies who underwent single-unit cord blood transplantation (CBT) with a conditioning regimen comprising 12-Gy total-body irradiation (TBI) and FLAG therapy (TBI/FLAG). Graft-versus-host disease (GVHD) prophylaxis consisted of tacrolimus or cyclosporin A and/or methotrexate. The median nucleated cell dose was 2.43 x 10(7)/kg (range: 1.96-3.55 x 10(7)/kg). Of 34 evaluable recipients, the cumulative incidence of donor engraftment was 97%. The median time to reach an absolute neutrophil count of 500/microL was 23 days (range: 18-35 days). The median time to an untransfused platelet count of 50,000/microL was 45.5 days (range: 28-208 days). Sixteen patients developed grades II-IV of acute GVHD. Fourteen patients were alive at a median follow-up of 46 months (range: 4-77 months). The estimated event-free survival at 3 years for all patients was 33.5%, with 72.7% in the standard-risk group (n = 11) and 17.7% in the high-risk group (n = 27) (P = .0075). These results showed that this novel regimen was well tolerated by patients and able to establish sustained donor cell engraftment, indicating the feasibility of TBI/FLAG as a conditioning regimen for CBT in adults with hematologic malignancies.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Okada
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Fujimori
authors.forename: Mahito
authors.initials: M
authors.lastname: Misawa
authors.forename: Shunro
authors.initials: S
authors.lastname: Kai
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nakajima
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Okikawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Satake
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Itoi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takatsuka
authors.forename: Takeyoshi
authors.initials: T
authors.lastname: Itsukuma
authors.forename: Keisuke
authors.initials: K
authors.lastname: Nishioka
authors.forename: Hiroya
authors.initials: H
authors.lastname: Tamaki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ikegame
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hara
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001772:Blood Cell Count; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D003561:Cytarabine; D005240:Feasibility Studies; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000517:prevention & control; D016179:Granulocyte Colony-Stimulating Factor; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D014740:Vidarabine / Q000031:analogs & derivatives; D014916:Whole-Body Irradiation
chemical_list: D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor; D014740:Vidarabine; C024352:fludarabine