title: Feasibility of reduced-intensity cord blood transplantation as salvage therapy for graft failure: results of a nationwide survey of adult patients.
abstract: To evaluate whether rescue with cord blood transplantation (CBT) could improve the poor survival after graft failure (GF), we surveyed the data of 80 adult patients (median age, 51 years) who received CBT within 3 months of GF (primary 64, secondary 16), with fludarabine-based reduced-intensity regimens with or without melphalan, busulfan, cyclophosphamide, and/or 2-4 Gy total-body irradiation (TBI). A median number of 2.4 × 10(7)/kg total nucleated cells (TNC) were infused, and among the 61 evaluable patients who survived for more than 28 days, 45 (74%) engrafted. The median follow-up of surviving patients was 325 days, and the 1-year overall survival rate was 33% despite poor performance status (2-4, 60%), carryover organ toxicities (grade 3/4, 14%), and infections (82%) prior to CBT. Day 100 transplantation-related mortality was 45%, with 60% related to infectious complications. Multivariate analysis showed that the infusion of TNC ≥2.5 × 10(7)/kg and an alkylating agent-containing regimen were associated with a higher probability of engraftment, and that high risk-status at the preceding transplantation and grade 3/4 organ toxicities before CBT were associated with an increased risk of mortality. In conclusion, in an older population of patients, our data support the feasibility of CBT with a reduced-intensity conditioning regimen for GF.
authors.affiliation: Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Fusako
authors.initials: F
authors.lastname: Waki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Masuoka
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fukuda
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
authors.forename: Mika
authors.initials: M
authors.lastname: Nakamae
authors.forename: Kimikazu
authors.initials: K
authors.lastname: Yakushijin
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Togami
authors.forename: Kaichi
authors.initials: K
authors.lastname: Nishiwaki
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Ueda
authors.forename: Fumio
authors.initials: F
authors.lastname: Kawano
authors.forename: Masaharu
authors.initials: M
authors.lastname: Kasai
authors.forename: Koji
authors.initials: K
authors.lastname: Nagafuji
authors.forename: Maki
authors.initials: M
authors.lastname: Hagihara
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hatanaka
authors.forename: Masafumi
authors.initials: M
authors.lastname: Taniwaki
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Maeda
authors.forename: Naoki
authors.initials: N
authors.lastname: Shirafuji
authors.forename: Takehiko
authors.initials: T
authors.lastname: Mori
authors.forename: Atae
authors.initials: A
authors.lastname: Utsunomiya
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Eto
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Makoto
authors.initials: M
authors.lastname: Murata
authors.forename: Toshiki
authors.initials: T
authors.lastname: Uchida
authors.forename: Hiroatsu
authors.initials: H
authors.lastname: Iida
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Yakushiji
authors.forename: Takuya
authors.initials: T
authors.lastname: Yamashita
authors.forename: Atsushi
authors.initials: A
authors.lastname: Wake
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takaue
authors.forename: Shuichi
authors.initials: S
authors.lastname: Taniguchi
mesh_terms: D000328:Adult; D002066:Busulfan / Q000008:administration & dosage; D036101:Cord Blood Stem Cell Transplantation / Q000401:mortality*; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality / Q000473:pathology* / Q000517:prevention & control*; D006085:Graft Survival / Q000276:immunology; D006086:Graft vs Host Disease / Q000276:immunology / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D018655:Lymphocyte Count; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D015999:Multivariate Analysis; D016879:Salvage Therapy / Q000379:methods; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D003520:Cyclophosphamide; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine; D008558:Melphalan