Current status of pediatric umbilical cord blood transplantation in Korea: a multicenter retrospective analysis of 236 cases.
We report the outcome of 236 pediatric umbilical cord blood transplantations (UCBT) performed in Korea. Given that the sources of the grafts were mostly unrelated donors (n = 226; 95.8%), only the results of unrelated UCBT were included for all statistics. The most frequent primary disease was acute leukemia (n = 167). In total, 91.7% of recipients were seropositive for cytomegalovirus (CMV). The median doses of nucleated cells and CD34+ cells were 4.84 × 10(7)/kg and 2.00 × 10(5)/kg, respectively. The median times to neutrophil (>0.5 × 10(9)/L) and platelet recovery (>20 × 10(9)/L) were 18 and 45 days, respectively. Grade 2-4 acute graft-versus-host-disease (GVHD) and chronic GVHD developed in 41.1 and 36.1% of cases, respectively. Forty-five patients developed CMV disease. The 5-year overall and event-free survival were 47.5 and 36.9%, respectively. Multivariate analysis revealed that adverse factors for survival of the whole cohort were total body irradiation-based conditioning (P = 0.007), salvage transplant (P = 0.001), failure to achieve early complete chimerism (P < 0.0005), and CMV disease (P = 0.001). The outcomes of the single- and double-unit UCBT (n = 64) were similar, while double-unit recipients were heavier (P < 0.0005) and older (P < 0.0005). We conclude that double-unit UCBT is a reasonable option for older or heavier children and that the thorough surveillance of CMV infection and the development of an effective CMV therapeutic strategy may be especially important for Korean children, whose CMV seroprevalence exceeds 90%.
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Keon Hee
KH
Yoo
Soo Hyun
SH
Lee
Ki Woong
KW
Sung
Hong Hoe
HH
Koo
Nak Gyun
NG
Chung
Bin
B
Cho
Hack Ki
HK
Kim
Hyoung Jin
HJ
Kang
Hee Young
HY
Shin
Hyo Seop
HS
Ahn
Hee Jo
HJ
Baek
Dong Kyun
DK
Han
Hoon
H
Kook
Tai Ju
TJ
Hwang
Sun Young
SY
Kim
Young Ho
YH
Lee
Jeong Ok
JO
Hah
Ho Joon
HJ
Im
Jong Jin
JJ
Seo
Sang Kyu
SK
Park
Hyun Joo
HJ
Jung
Jun Eun
JE
Park
Yeon Jung
YJ
Lim
Seong Shik
SS
Park
Young Tak
YT
Lim
Eun Sun
ES
Yoo
Kyung Ha
KH
Ryu
Hyeon Jin
HJ
Park
Byung Kiu
BK
Park
D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D003586:Cytomegalovirus Infections / Q000209:etiology; D018572:Disease-Free Survival; D005260:Female; D005312:Fetal Blood / Q000637:transplantation*; D006086:Graft vs Host Disease / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007938:Leukemia / Q000601:surgery; D008297:Male; D015999:Multivariate Analysis; D056910:Republic of Korea; D012189:Retrospective Studies; D016896:Treatment Outcome
D006680:HLA Antigens