title: Single-unit umbilical cord blood transplantation from unrelated donors in adult patients with chronic myelogenous leukemia.
abstract: Clinical studies focused on outcomes of umbilical cord blood transplantation (UCBT) for patients with chronic myelogenous leukemia (CML) in need of allogeneic stem cell transplantation and lacking an HLA-matched adult donor are limited. We analyzed the outcome of 26 adults with CML receiving single-unit UCBT from unrelated donors after myeloablative conditioning at a single institution. Conditioning regimens were based on combinations of thiotepa, busulfan, cyclophospamide or fludarabine, and antithymocyte globulin. At the time of transplantation, 7 patients (27%) were in first chronic phase (CP), 11 (42%) were in second CP, 2 (8%) were in accelerated phase (AP), and 6 (23%) were in blast crisis (BC). The cumulative incidence (CI) of myeloid engraftment was 88% at a median time of 22 days and was significantly better for patients receiving higher doses of CD34(+) cells. The CI of acute graft-versus-host disease (GVHD) grade II-IV was 61%, that of acute GVHD grade III-IV was 39%, and that of chronic extensive GVHD was 60%. Treatment-related mortality (TRM) was 41% for patients undergoing UCBT while in first or second CP and 100% for patients in AP or BC (P < .01). After a median follow-up of 8 years, none of the patients relapsed, giving an overall disease-free survival (DFS) at 8 years of 41%. The DFS for patients undergoing UCBT while in any CP was 59%. These results demonstrate that UCBT from unrelated donors can be a curative treatment for a substantial number of patients with CML. Advances in supportive care and better selection of cord blood units and patients are needed to improve TRM.
authors.affiliation: Department of Hematology, Hospital Universitario La Fe, Valencia, Spain. sanz_jai@gva.es
authors.forename: Jaime
authors.initials: J
authors.lastname: Sanz
authors.forename: Pau
authors.initials: P
authors.lastname: Montesinos
authors.forename: Silvana
authors.initials: S
authors.lastname: Saavedra
authors.forename: Ignacio
authors.initials: I
authors.lastname: Lorenzo
authors.forename: Leonor
authors.initials: L
authors.lastname: Senent
authors.forename: Dolores
authors.initials: D
authors.lastname: Planelles
authors.forename: Luis
authors.initials: L
authors.lastname: Larrea
authors.forename: Guillermo
authors.initials: G
authors.lastname: Martín
authors.forename: Javier
authors.initials: J
authors.lastname: Palau
authors.forename: Isidro
authors.initials: I
authors.lastname: Jarque
authors.forename: Jesús
authors.initials: J
authors.lastname: Martínez
authors.forename: Javier
authors.initials: J
authors.lastname: de la Rubia
authors.forename: Federico
authors.initials: F
authors.lastname: Moscardó
authors.forename: David
authors.initials: D
authors.lastname: Martinez
authors.forename: Inés
authors.initials: I
authors.lastname: Gómez
authors.forename: María
authors.initials: M
authors.lastname: López
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Sanz
authors.forename: Guillermo F
authors.initials: GF
authors.lastname: Sanz
mesh_terms: D000293:Adolescent; D000328:Adult; D001782:Blood Donors; D002423:Cause of Death; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000453:epidemiology; D006648:Histocompatibility; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000175:diagnosis / Q000628:therapy*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D010976:Platelet Count; D012008:Recurrence; D012189:Retrospective Studies; D018183:Transplantation Chimera; D016896:Treatment Outcome; D055815:Young Adult