title: Outcome following unrelated cord blood transplant in 136 patients with malignant and non-malignant diseases: a report from the Australian and New Zealand children's haematology and oncology group.
abstract: Unrelated umbilical cord blood (UCB) is an alternative stem cell source for paediatric patients lacking a matched related or unrelated marrow donor. We report the results of all paediatric unrelated UCB transplants performed in Australia and New Zealand over a 10-year period. A total of 135 patients were transplanted, 100 for malignant disease (74%) and 35 for non-malignant disorders. The majority (88%) of patients received an HLA-mismatched graft. The median infused total nucleated cell dose was 4.7 x 10(7)/kg and CD34+ count 1.9 x 10(5)/kg. Neutrophil engraftment occurred in 83% of patients by day 42 (median 23 days) and platelet engraftment in 55% by day 60 (median 56 days). Grades II-IV and III-IV acute GVHD occurred in 41 and 18% of patients, respectively. TRM and overall survival 1-year post transplant were 32 and 61%, respectively. A higher probability of neutrophil recovery (P=0.004) and faster time to recovery (median 18 days vs 26 days, P=0.008) were observed in recipients of a cord unit with a CD34 cell dose >or=1.7 x 10(5)/kg. Our results support selection of cord units with CD34 cell doses >or=1.7 x 10(5)/kg to promote faster engraftment, improve survival and lower TRM.
authors.affiliation: Centre for Children's Cancer & Blood Disorders, Sydney Children's Hospital, Sydney, New South Wales, Australia.
authors.forename: T E
authors.initials: TE
authors.lastname: Petterson
authors.forename: M
authors.initials: M
authors.lastname: Gabriel
authors.forename: K
authors.initials: K
authors.lastname: Tiedemann
authors.forename: L
authors.initials: L
authors.lastname: Teague
authors.forename: P J
authors.initials: PJ
authors.lastname: Shaw
authors.forename: D
authors.initials: D
authors.lastname: Baker
authors.forename: R
authors.initials: R
authors.lastname: Bolton-Jones
authors.forename: H
authors.initials: H
authors.lastname: Tapp
authors.forename: C
authors.initials: C
authors.lastname: Oswald
authors.forename: M R
authors.initials: MR
authors.lastname: Vowels
authors.forename: T A
authors.initials: TA
authors.lastname: O'Brien
mesh_terms: D018952:Antigens, CD34 / Q000097:blood / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D005312:Fetal Blood / Q000276:immunology / Q000637:transplantation*; D006086:Graft vs Host Disease / Q000276:immunology; D006402:Hematologic Diseases / Q000517:prevention & control / Q000628:therapy*; D006410:Hematopoiesis; D006801:Humans; D009504:Neutrophils / Q000276:immunology / Q000637:transplantation; D012044:Regression Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D018952:Antigens, CD34