Feasibility of reduced-intensity cord blood transplantation as salvage therapy for graft failure: results of a nationwide survey of adult patients.
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.
Waki
Fusako
F
Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan.
Masuoka
Kazuhiro
K
Fukuda
Takahiro
T
Kanda
Yoshinobu
Y
Nakamae
Mika
M
Yakushijin
Kimikazu
K
Togami
Katsuhiro
K
Nishiwaki
Kaichi
K
Ueda
Yasunori
Y
Kawano
Fumio
F
Kasai
Masaharu
M
Nagafuji
Koji
K
Hagihara
Maki
M
Hatanaka
Kazuo
K
Taniwaki
Masafumi
M
Maeda
Yoshinobu
Y
Shirafuji
Naoki
N
Mori
Takehiko
T
Utsunomiya
Atae
A
Eto
Tetsuya
T
Nakagawa
Hitoshi
H
Murata
Makoto
M
Uchida
Toshiki
T
Iida
Hiroatsu
H
Yakushiji
Kazuaki
K
Yamashita
Takuya
T
Wake
Atsushi
A
Takahashi
Satoshi
S
Takaue
Yoichi
Y
Taniguchi
Shuichi
S
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
D003520:Cyclophosphamide; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine; D008558:Melphalan