title: Results of a pilot study on the use of third-party donor mesenchymal stromal cells in cord blood transplantation in adults.
abstract: OBJECTIVE
  Cord blood (CB) transplants with co-infusion of third-party donor (TPD) mobilized hematopoietic stem cells (MHSC) have been shown to result in 'bridge' engraftment with prompt neutrophil recovery and high final rates of CB engraftment and full chimerism. This strategy overcomes the limitation posed by low cellularity of CB units for unrelated transplants in adults. Enhancement of adaptive immunity reconstitution without increasing risks of graft-versus-host disease (GvHD) is required to optimize results further. Our objectives were to evaluate co-infusion of mesenchymal stromal cells (MSC) from the same TPD regarding tolerance, CB engraftment and effects on acute (a)GvHD, both preventive and therapeutic.
  
  
  METHODS
  Ex vivo-expanded bone marrow MSC were infused at the time of the transplant or the in case of refractory aGvHD.
  
  
  RESULTS
  Nine patients received 1.04 - 2.15 x 10(6)/kg (median 1.20) MSC immediately after CB and TPD MHSC. Neither immediate adverse side-effects nor significant differences regarding CB engraftment or aGvHD development were observed. Four patients developed grade II aGvHD, refractory to steroids in two. These reached complete remission after therapeutic infusions of MSC.
  
  
  CONCLUSIONS
  In recipients of 'dual CB/TPD MHSC transplants', MSC infusions were therapeutically effective for severe aGvHD but no significant differences in CB engraftment and incidence of severe aGvHD were observed following their prophylactic use. Although results of this study alone cannot conclusively determine the application of MSC in CB transplantation, we believe that, in this setting, the best use of MSC could be as pre-emptive treatment for aGvHD.
authors.affiliation: Hospital Universitario Puerta de Hierro, Universidad Autonoma de Madrid, Madrid, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Gonzalo-Daganzo
authors.forename: Carmen
authors.initials: C
authors.lastname: Regidor
authors.forename: Trinidad
authors.initials: T
authors.lastname: Martín-Donaire
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Rico
authors.forename: Guiomar
authors.initials: G
authors.lastname: Bautista
authors.forename: Isabel
authors.initials: I
authors.lastname: Krsnik
authors.forename: Rafael
authors.initials: R
authors.lastname: Forés
authors.forename: Emilio
authors.initials: E
authors.lastname: Ojeda
authors.forename: Isabel
authors.initials: I
authors.lastname: Sanjuán
authors.forename: Jose A
authors.initials: JA
authors.lastname: García-Marco
authors.forename: Belen
authors.initials: B
authors.lastname: Navarro
authors.forename: Santiago
authors.initials: S
authors.lastname: Gil
authors.forename: Rocio
authors.initials: R
authors.lastname: Sánchez
authors.forename: Nuria
authors.initials: N
authors.lastname: Panadero
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Gutiérrez
authors.forename: Miguel
authors.initials: M
authors.lastname: García-Berciano
authors.forename: Nuria
authors.initials: N
authors.lastname: Pérez
authors.forename: Isabel
authors.initials: I
authors.lastname: Millán
authors.forename: Rafael
authors.initials: R
authors.lastname: Cabrera
authors.forename: Manuel N
authors.initials: MN
authors.lastname: Fernández
mesh_terms: D000208:Acute Disease; D000328:Adult; D001853:Bone Marrow / Q000378:metabolism; D002452:Cell Count; D046528:Chimerism; D005260:Female; D005312:Fetal Blood / Q000166:cytology; D006086:Graft vs Host Disease / Q000276:immunology* / Q000473:pathology / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000276:immunology / Q000628:therapy*; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation; D059630:Mesenchymal Stem Cells / Q000166:cytology / Q000276:immunology / Q000378:metabolism*; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology / Q000473:pathology; D010865:Pilot Projects; D012074:Remission Induction; D017154:Stromal Cells / Q000166:cytology / Q000276:immunology / Q000378:metabolism*; D014019:Tissue Donors; D014184:Transplantation, Homologous