title: Reduced-intensity conditioning with combined haploidentical and cord blood transplantation results in rapid engraftment, low GVHD, and durable remissions.
abstract: We conducted a 45 patient prospective study of reduced-intensity conditioning (RIC) and transplantation of unrelated umbilical cord blood (UCB) and CD34(+) stem cells from a haploidentical family member. Median age was 50 years; weight was 80 kg. Fifty-eight percent had active disease. Neutrophil engraftment occurred at 11 days (interquartile range [IQR], 9-15) and platelet engraftment at 19 days (IQR, 15-33). In the majority of patients, early haploidentical engraftment was replaced by durable engraftment of UCB by 100 days, with regular persistence of minor host and/or haplo-hematopoiesis. Percentage of haplochimerism at day 100 correlated with the haplo-CD34 dose (P = .003). Cumulative incidence of acute GVHD (aGVHD) was 25% and chronic GVHD (cGVHD) was 5%. Actuarial survival at 1 year was 55%, progression-free survival (PFS) was 42%, nonrelapse mortality (NRM) was 28%, and relapse was 30%. RIC and haplo-cord transplantation results in fast engraftment of neutrophils and platelets, low incidences of aGVHD and cGVHD, low frequency of delayed opportunistic infections, reduced transfusion requirements, shortened length of hospital stay, and promising long-term outcomes. UCB cell dose had no impact on time to hematopoietic recovery. Therefore, UCB selection can prioritize matching, and better matched donors can be identified rapidly for most patients. This study is registered at http://clinicaltrials.gov as NCI clinical trial no. NCT00943800.
authors: Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, USA.
authors: Hongtao
authors: H
authors: Liu
authors: Elizabeth S
authors: ES
authors: Rich
authors: Lucy
authors: L
authors: Godley
authors: Olatoyosi
authors: O
authors: Odenike
authors: Loren
authors: L
authors: Joseph
authors: Susana
authors: S
authors: Marino
authors: Justin
authors: J
authors: Kline
authors: Vu
authors: V
authors: Nguyen
authors: John
authors: J
authors: Cunningham
authors: Richard A
authors: RA
authors: Larson
authors: Paula
authors: P
authors: del Cerro
authors: Linda
authors: L
authors: Schroeder
authors: Lisa
authors: L
authors: Pape
authors: Wendy
authors: W
authors: Stock
authors: Amittha
authors: A
authors: Wickrema
authors: Andrew S
authors: AS
authors: Artz
authors: Koen
authors: K
authors: van Besien
mesh_terms: D000328:Adult; D053687:Adult Stem Cells / Q000378:metabolism / Q000637:transplantation; D000368:Aged; D018952:Antigens, CD34 / Q000378:metabolism; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D006239:Haplotypes; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects; D010865:Pilot Projects; D012074:Remission Induction; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D018952:Antigens, CD34