title: Outcomes, infections, and immune reconstitution after double cord blood transplantation in patients with high-risk hematological diseases.
abstract: Double unrelated cord blood transplant (dUCBT) has been used to circumvent cell dose limitation of single UCBT; however, few data are available describing outcomes, infectious disease, and immune recovery. We analyzed 35 consecutive dUCBT recipients with high-risk malignant disorders (n=21) and bone marrow failure syndromes (n=14). Median follow-up was 32 months. Conditioning regimen was myeloablative in 14 and reduced intensity in 21 patients. Median infused nucleated cell dose was 4 × 10(7) /kg. Median time to absolute neutrophil count >0.5 × 10(9) /L was 25 days. Cumulative incidence (CI) of acute grade II-IV graft-versus-host disease was 47%. Estimated overall survival at 2 years was 48%. CI of first viral infections at 1 year was 92%. We observed 49 viral infections in 30 patients, 34 bacterial infections in 19 patients, and 16 fungal or parasitic infections in 12 patients. Lymphocyte subset analyses were performed at 3, 6, 9, and >12 months after dUCBT. Decreased T-cell and B-cell counts with expansion of natural killer cells were observed until 9 months post transplantation. Recovery of thymopoiesis measured by T-cell receptor excision circles was impaired until 9 months after dUCBT, when the appearance of new thymic precursors was observed. Delayed immune recovery and high incidence of infectious complications were observed after dUCBT in patients with high-risk hematological diseases.
authors.affiliation: Service d'Hématologie-Greffe, Hôpital Saint Louis, APHP, Paris University 7, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Ruggeri
authors.forename: R
authors.initials: R
authors.lastname: Peffault de Latour
authors.forename: M
authors.initials: M
authors.lastname: Carmagnat
authors.forename: E
authors.initials: E
authors.lastname: Clave
authors.forename: C
authors.initials: C
authors.lastname: Douay
authors.forename: J
authors.initials: J
authors.lastname: Larghero
authors.forename: J-M
authors.initials: JM
authors.lastname: Cayuela
authors.forename: R
authors.initials: R
authors.lastname: Traineau
authors.forename: M
authors.initials: M
authors.lastname: Robin
authors.forename: A
authors.initials: A
authors.lastname: Madureira
authors.forename: P
authors.initials: P
authors.lastname: Ribaud
authors.forename: C
authors.initials: C
authors.lastname: Ferry
authors.forename: A
authors.initials: A
authors.lastname: Devergie
authors.forename: D
authors.initials: D
authors.lastname: Purtill
authors.forename: C
authors.initials: C
authors.lastname: Rabian
authors.forename: E
authors.initials: E
authors.lastname: Gluckman
authors.forename: A
authors.initials: A
authors.lastname: Toubert
authors.forename: G
authors.initials: G
authors.lastname: Socié
authors.forename: V
authors.initials: V
authors.lastname: Rocha
mesh_terms: D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic; D001424:Bacterial Infections / Q000209:etiology; D001855:Bone Marrow Diseases; D000080983:Bone Marrow Failure Disorders; D002648:Child; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D005260:Female; D006457:Hemoglobinuria, Paroxysmal / Q000628:therapy; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology; D009369:Neoplasms / Q000628:therapy; D010272:Parasitic Diseases / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014777:Virus Diseases / Q000209:etiology; D055815:Young Adult