title: A "no-wash" albumin-dextran dilution strategy for cord blood unit thaw: high rate of engraftment and a low incidence of serious infusion reactions.
abstract: Preparation of cord blood (CB) units for infusion by albumin-dextran dilution without centrifugation may be advantageous for adult patients to minimize cell loss and, unlike a bedside thaw, is still conducted in the controlled laboratory environment. Therefore, we studied CB transplantation (CBT) using this technique in 54 consecutive CBT recipients >20 kg. Patients (median age=42 years [range: 7-66 years]; median weight=71 kg [range: 24-109]) were transplanted for high-risk hematologic malignancies with myeloablative (n=35) or nonmyeloablative (n=19) conditioning and 4-6/6 human leukocyte antigen (HLA)-matched double-unit grafts. One hundred seven units were thawed with dilution, whereas 1 red blood cell (RBC)-replete unit was washed. A 5:1 dextran 40%/25% albumin solution was used. RBC-depleted units (n=104) were diluted >or=5.5-fold (median final volume 200 mL [range: 200-500]), whereas RBC-replete units (n=3) were diluted >or=4-fold (median final volume 400 mL [range: 400-535]). Total nucleated cell (TNC) recovery was 86%; the median infused TNC dose was 2.17x10(7)/kg/unit. Although 35 patients (65%) had a total of 45 infusion reactions (6 nausea, 31 hypertension, 3 pain, 1 rigors/fever, 2 transient hypoxia, 2 renal impairment) requiring additional therapy, there were no infusion-related serious adverse events, and reactions were not related to dimethyl sulfoxide (DMSO) dose/kg. Cumulative incidence of sustained donor engraftment was 94% (95% cumulative incidence [CI]: 87-100) with neutrophil recovery occurring at a median of 25 days (range: 13-43) in myeloablative and 10 days (range: 7-36) in nonmyeloablative recipients. CB thaw with albumin-dextran dilution reduces unit manipulation, and minimizes cell loss, speeds time to infusion, is associated with a tolerable infusion reaction profile, and a high rate of sustained engraftment in CBT recipients >or=20 kg.
authors.affiliation: Department of Medicine, Allogeneic Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. barkerj@mskcc.org
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Barker
authors.forename: Michelle
authors.initials: M
authors.lastname: Abboud
authors.forename: Robert D
authors.initials: RD
authors.lastname: Rice
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hawke
authors.forename: Allison
authors.initials: A
authors.lastname: Schaible
authors.forename: Glenn
authors.initials: G
authors.lastname: Heller
authors.forename: Vincent
authors.initials: V
authors.lastname: La Russa
authors.forename: Andromachi
authors.initials: A
authors.lastname: Scaradavou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000418:Albumins; D001793:Blood Preservation / Q000379:methods*; D002648:Child; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D015925:Cryopreservation / Q000379:methods*; D003911:Dextrans; D004121:Dimethyl Sulfoxide; D005260:Female; D005312:Fetal Blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000418:Albumins; D003911:Dextrans; D004121:Dimethyl Sulfoxide