title: Intrabone marrow transplantation of unwashed cord blood using reduced-intensity conditioning treatment: a phase I study.
abstract: The outcome of cord blood transplantation following reduced-intensity conditioning is suboptimal because of fatal infection triggered by prolonged neutropenia and graft-versus-host disease (GVHD) in addition to graft rejection. Intrabone marrow injection (IBMI) may improve the outcome by providing better hematopoietic engraftment and less GVHD. We therefore evaluated IBMI safety in reduced-intensity stem cell transplantation. Furthermore, we used unwashed cord blood to avoid stem cell loss. Ten patients (median age = 61 years old) were enrolled. Cord blood cells were thawed at the bedside and injected into 4 iliac bone sites (2 at each hemipelvis). The procedure was well tolerated with no injection-related complications. Nine patients achieved donor engraftment. The median time to neutrophil recovery (>0.5 × 10(9)/L) was 17 days, and platelet recovery was achieved in 8 patients. Early full donor chimerism was achieved (median of 15 and 20 days in T cells and myeloid cells, respectively). Three of 9 evaluable patients developed grade II to III GVHD, and 5 of 10 patients died of treatment-related toxicities. The probability of survival at 1 year was 46.7%. IBMI of unwashed cord blood following reduced-intensity conditioning is safe, well tolerated, and may lead to an increased donor engraftment rate.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Okada
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yoshihara
authors.forename: Kyoko
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Katsuji
authors.initials: K
authors.lastname: Kaida
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ikegame
authors.forename: Ruri
authors.initials: R
authors.lastname: Kato
authors.forename: Hiroya
authors.initials: H
authors.lastname: Tamaki
authors.forename: Takayuki
authors.initials: T
authors.lastname: Inoue
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Soma
authors.forename: Shunro
authors.initials: S
authors.lastname: Kai
authors.forename: Shunichi
authors.initials: S
authors.lastname: Kato
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D016026:Bone Marrow Transplantation; D002452:Cell Count; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006086:Graft vs Host Disease / Q000276:immunology / Q000517:prevention & control*; D006650:Histocompatibility Testing; D006801:Humans; D017148:Infusions, Intraosseous; D007564:Japan; D007938:Leukemia / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology; D018183:Transplantation Chimera / Q000276:immunology; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous