title: The intra-bone marrow injection of cord blood cells extends the possibility of transplantation to the majority of patients with malignant hematopoietic diseases.
abstract: Cord blood transplant (CBT) in adult patients is scarcely utilized because of the risk of graft failure or very delayed platelet recovery. To improve the capacity and the speed to engraft, we have developed an intra-bone (IB) cord blood transplant technique. 75 patients with hematological malignancies, categorized by disease phase as early (18%), intermediate (20%) and advanced (62%), were transplanted. The median cell dose (TNC) infused was: 2.6 (1.35-5.4)×10(7)/kg; the HLA disparity was: 12 cases=5/6, 62 cases=4/6 and 1 case=3/6 matched antigens. 72/75 patients engrafted (96%); median day of recovery of neutrophils (PMN) >500×10(9)/L and platelets (PLT) >20 000×10(9)/L was: 23 (14-44) and 35 (16-70) days respectively. The outcomes at 2 years according to Kaplan-Meier are: OS=46%±5; RI=18%±2; NRM=39%±5. Acute GVHD incidence/severity was: grade 0-I=64%, II=14%, III-IV=0%. The incidence of Chronic GVHD was globally low but in 3 cases was very severe. Intra-bone CBT is associated with high rate of engraftment, early and robust platelet recovery, low incidence of acute GVHD. A very promising aspect is that the relapse rate is low considering the advanced phase of the disease in two/thirds of patients. A suitable CBU was found for nearly every patient searching for a CBU. Therefore, IB CBT extends the possibility to transplant any patient for whom this approach represents the sole possibility of long-term survival.
authors.affiliation: Centro Cellule Staminali e Terapia Cellulare, Ospedale San Martino, Genova, Italy. francesco.frassoni@hsanmartino.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Frassoni
authors.forename: Riccardo
authors.initials: R
authors.lastname: Varaldo
authors.forename: Francesca
authors.initials: F
authors.lastname: Gualandi
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: GianMario
authors.initials: G
authors.lastname: Sambuceti
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Sacchi
authors.forename: Marina
authors.initials: M
authors.lastname: Podestà
mesh_terms: D000208:Acute Disease; D000328:Adult; D001853:Bone Marrow; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000401:mortality; D006680:HLA Antigens; D006402:Hematologic Diseases / Q000401:mortality / Q000628:therapy*; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D015996:Survival Rate; D014184:Transplantation, Homologous
chemical_list: D006680:HLA Antigens