title: Results of the Cord Blood Transplantation Study (COBLT): clinical outcomes of unrelated donor umbilical cord blood transplantation in pediatric patients with hematologic malignancies.
abstract: Outcomes of unrelated donor cord blood transplantation in 191 hematologic malignancy children (median age, 7.7 years; median weight, 25.9 kg) enrolled between 1999 and 2003 were studied (median follow-up, 27.4 months) in a prospective phase 2 multicenter trial. Human leukocyte antigen (HLA) matching at enrollment was 6/6 (n = 17), 5/6 (n = 58), 4/6 (n = 111), or 3/6 (n = 5) by low-resolution HLA-A, -B, and high-resolution (HR) DRB1. Retrospectively, 179 pairs were HLA typed by HR. The median precryopreservation total nucleated cell (TNC) dose was 5.1 x 10(7) TNC/kg (range, 1.5-23.7) with 3.9 x 10(7) TNC/kg (range, 0.8-22.8) infused. The median time to engraftment (absolute neutrophil count > 500/mm(3) and platelets 50 000/muL) was 27 and 174 days. The cumulative incidence of neutrophil engraftment by day 42 was 79.9% (95% confidence interval [CI], 75.1%-85.2%); acute grades III/IV GVHD by day 100 was 19.5% (95% CI, 13.9%-25.5%); and chronic GVHD at 2 years was 20.8% (95% CI, 14.8%-27.7%). HR matching decreased the probability of severe acute GVHD. The cumulative incidence of relapse at 2 years was 19.9% (95% CI, 14.8%-25.7%). The probabilities of 6-month and 2-year survivals were 67.4% and 49.5%. Unrelated donor cord blood transplantation from partially HLA-mismatched units can cure many children with leukemias. The study was registered at www.clinicaltrials.gov as #NCT00000603.
authors: Duke University Medical Center, Durham, NC, USA. kurtz001@mc.duke.edu
authors: Joanne
authors: J
authors: Kurtzberg
authors: Vinod K
authors: VK
authors: Prasad
authors: Shelly L
authors: SL
authors: Carter
authors: John E
authors: JE
authors: Wagner
authors: Lee Ann
authors: LA
authors: Baxter-Lowe
authors: Donna
authors: D
authors: Wall
authors: Neena
authors: N
authors: Kapoor
authors: Eva C
authors: EC
authors: Guinan
authors: Stephen A
authors: SA
authors: Feig
authors: Elizabeth L
authors: EL
authors: Wagner
authors: Nancy A
authors: NA
authors: Kernan
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D018572:Disease-Free Survival; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000097:blood / Q000401:mortality*; D006680:HLA Antigens / Q000097:blood; D019337:Hematologic Neoplasms / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007223:Infant; D007958:Leukocyte Count / Q000379:methods; D008297:Male; D010976:Platelet Count / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014184:Transplantation, Homologous
chemical_list: D006680:HLA Antigens