title: Clinical outcomes of unrelated donor umbilical cord blood transplantation for 30 adults with hematological malignancies.
abstract: 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.
authors.affiliation: Department of Hematology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Maeda
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Hara
authors.forename: Miyuki
authors.initials: M
authors.lastname: Nishie-Kataoka
authors.forename: Hisakazu
authors.initials: H
authors.lastname: Nishimori
authors.forename: Haruko
authors.initials: H
authors.lastname: Sugiyama
authors.forename: Noriko
authors.initials: N
authors.lastname: Namba
authors.forename: Shiro
authors.initials: S
authors.lastname: Kubonishi
authors.forename: Masami
authors.initials: M
authors.lastname: Niiya
authors.forename: Katsuji
authors.initials: K
authors.lastname: Shinagawa
authors.forename: Kazuma
authors.initials: K
authors.lastname: Ikeda
authors.forename: Mitsune
authors.initials: M
authors.lastname: Tanimoto
mesh_terms: 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