Cord blood transplants supported by co-infusion of mobilized hematopoietic stem cells from a third-party donor.
This open label clinical study provides updated evaluation of the strategy of single unit cord blood transplants (CBTs) with co-infusion of third-party donor (TPD) mobilized hematopoietic stem cells (MHSC). Fifty-five adults with high-risk hematological malignancies, median age 34 years (16-60 years) and weight 70 kg (43-95 kg), received CBTs (median 2.39 x 10(7) total nucleated cell (TNC) per kg and 0.11 x 10(6) CD34+ per kg) and TPD-MHSC (median 2.4 x 10(6) CD34+ per kg and 3.2 x 10(3) CD3+ per kg). Median time to ANC and to CB-ANC >0.5 x 10(9)/l as well as to full CB-chimerism was 10, 21 and 44 days, with maximum cumulative incidences (MCI) of 0.96, 0.95 and 0.91. Median time to unsupported platelets >20 x 10(9)/l was 32 days (MCI 0.78). MCI for grades I-IV and III-IV acute GVHD (aGVHD) were 0.62 and 0.11; 12 of 41 patients (29%) who are at risk developed chronic GVHD, becoming severely extensive in three patients. Relapses occurred in seven patients (MCI=0.17). The main causes of morbi-mortality were post-engraftment infections. CMV reactivations were the most frequent, their incidence declining after the fourth month. Five-year overall survival and disease-free survival (Kaplan-Meier) were 56 % and 47% (63% and 54% for patients <or=40 years). In conclusion, CBT with single units of relatively low cell content and 0-3 HLA mismatches is feasible as a first choice option for adult patients who lack a readily available adequate adult donor.
Servicio de Hematología, Universidad Autónoma de Madrid, Hospital Universitario Puerta de Hierro, Madrid, Spain.
G
G
Bautista
J R
JR
Cabrera
C
C
Regidor
R
R
Forés
J A
JA
García-Marco
E
E
Ojeda
I
I
Sanjuán
E
E
Ruiz
I
I
Krsnik
B
B
Navarro
S
S
Gil
E
E
Magro
A
A
de Laiglesia
R
R
Gonzalo-Daganzo
T
T
Martín-Donaire
M
M
Rico
I
I
Millán
M N
MN
Fernández
D000293:Adolescent; D000328:Adult; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors