title: Prospective study of one- vs two-unit umbilical cord blood transplantation following reduced intensity conditioning in adults with hematological malignancies.
abstract: As the threshold nucleated cell dose for one-unit umbilical cord blood (UCB) in adults has not to date been firmly established, we prospectively compared one- vs two-unit UCB transplantation after reduced intensity conditioning (RIC) in adult patients with hematological malignancies. Study design specified one-UCB unit if the cryopreserved total nucleated cell (TNC) dose was 2.5 × 10(7)/kg recipient weight, otherwise two units matched at minima of 4/6 HLA loci to the patient and 3/6 to each other were infused. A total of 27 patients received one unit; 23 patients received two units. Median time to ANC >500/μL was 24 days (95% confidence interval 22-28 days), 25 days for one unit and 23 days for two units (P=0.99). At day 100, ANC >500/μL was 88.4 and 91.3% in the one- and two-unit groups (P=0.99), respectively. Three-year EFS was 28.6% and 39.1% in the one- and two-unit groups (P=0.71), respectively. Infusion of two units was associated with a significantly lower relapse risk, 30.4% vs 59.3% (P=0.045). Infused cell doses (TNC, CD3(+), CD34(+) and CD56(+)CD3(neg)) did not impact on engraftment, OS or EFS. Taken together, one-unit UCB transplantation with a threshold cell dose 2.5 × 10(7)/kg recipient weight after RIC is a viable option for adults, although infusion of two units confers a lower relapse incidence.
authors: Department of Medicine, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA.
authors: T L
authors: TL
authors: Kindwall-Keller
authors: Y
authors: Y
authors: Hegerfeldt
authors: H J
authors: HJ
authors: Meyerson
authors: S
authors: S
authors: Margevicius
authors: P
authors: P
authors: Fu
authors: W
authors: W
authors: van Heeckeren
authors: H M
authors: HM
authors: Lazarus
authors: B W
authors: BW
authors: Cooper
authors: S L
authors: SL
authors: Gerson
authors: P
authors: P
authors: Barr
authors: W W
authors: WW
authors: Tse
authors: C
authors: C
authors: Curtis
authors: L R
authors: LR
authors: Fanning
authors: R J
authors: RJ
authors: Creger
authors: J M
authors: JM
authors: Carlson-Barko
authors: M J
authors: MJ
authors: Laughlin
mesh_terms: D000328:Adult; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D019337:Hematologic Neoplasms / Q000628:therapy*; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology; D011446:Prospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult