Clinical outcomes of unrelated donor umbilical cord blood transplantation for 30 adults with hematological malignancies.
BACKGROUND
Umbilical cord blood transplantation (CBT) has increasingly been used as a therapeutic option for adult patients for whom allogeneic stem-cell transplantation is not indicated, due to the availability of cord blood. However, myeloablative conditioning regimens are associated with significant mortality, and high relapse rates in reduced-intensity regimens may result in a poor rate of disease-free survival for those with advanced stages of hematological malignancies. Therefore, it remains unknown whether CBT is a truly effective option for such adults with high-risk disease, as well as for those with standard-risk disease.


METHODS
Thirty adult patients with a median age of 45 years (range: 16-67) with standard or high-risk disease underwent CBT from unrelated donors at Okayama University Hospital between October 2002 and May 2007. Twenty-one patients had diseases classified as high-risk for transplantation. The median number of nucleated cells in infused cord blood was 2.65 x 10(7)/kg (range: 1.73-4.87).


RESULTS
Twenty-three patients achieved neutrophil engraftment at a median time of 22 days (range: 13-42) after CBT. The cumulative incidence of grade II to IV acute graft-versus-host disease (GVHD) was 53.6% . Out of the 30 patients, 11 were alive and disease-free at a median time of 446 days (range: 124-1153) after CBT. The cumulative 1-year overall survival in patients with standard-risk or high-risk disease was 63.5% and 15.4%, respectively (p=0.01).


CONCLUSIONS
Although from a retrospective study, these results suggest that unrelated donor CBT could be safe and effective for adult patients with standard-risk disease who cannot find a suitable HLA-matched volunteer marrow or peripheral blood donor.
Kobayashi
Koichiro
K
Department of Hematology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
Maeda
Yoshinobu
Y
Hara
Yoshitaka
Y
Nishie-Kataoka
Miyuki
M
Nishimori
Hisakazu
H
Sugiyama
Haruko
H
Namba
Noriko
N
Kubonishi
Shiro
S
Niiya
Masami
M
Shinagawa
Katsuji
K
Ikeda
Kazuma
K
Tanimoto
Mitsune
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D006086:Graft vs Host Disease; D019337:Hematologic Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D055815:Young Adult