title: [Unrelated umbilical cord blood transplantation with TBI/Ara-c/CY non-ATG conditioning regimen for adults with hematologic malignancies].
abstract: OBJECTIVE
  To retrospectively analyze the curative efficacy of umbilical cord blood transplantation (UCBT) with improved myeloablative conditioning regimen (total body irradiation (TBI)/cytosine arabinoside (Ara-c)/cyclophosphamide (CY) without antithymocyte globulin (ATG)) in adult patients with hematological malignancies.
  
  
  METHODS
  Forty consecutive adult patients with hematological malignancies received improved myeloablative unrelated CBT at a single center from September 2006 to May 2011. Their average age was (23 ± 6) years and the average weight (58 ± 9) kg. Thirty-five (87.5%) patients were high-risk and 15 (37.5%) at the advanced disease status at pre-transplantation. They received 1 (n = 23) or 2 (n = 17) cord blood units. Seventy-five percent of them were transplanted with 1/2-human leukocyte antigen mismatched unit. The conditioning regimen consisted of 12 Gy TBI, granulocyte colony-stimulating factor (G-CSF) plus Ara-c and CY without ATG. All patients received a combination of cyclosporine (CsA) and mycophenolate mofetil (MMF) for the prophylaxis of graft-versus-host disease (GVHD).
  
  
  RESULTS
  For the entire group of patients, the average cell doses infused were (4.1 ± 1.1)×10⁷ total nucleated cells/kg and (2.4 ± 1.0)×10⁵ CD34(+) cells/kg. All patients acquired engraftment with an implantation rate of 100%. The average time of absolute neutrophil count (ANC) ≥ 0.5×10⁹/L was (20 ± 5) days and the average time of platelet ≥ 20×10⁹/L was(38 ± 12) days. Acute GVHD occurred in 23 patients (57.5%) and 4 (10.0%) were of grade III-IV. Chronic GVHD occurred in 22.9% (8/35) evaluable patients. Relapse occurred in 12.5% (5/40) patients. During a median follow-up period of 19.8 (range 4.6 - 55.0) months, the transplantation-related mortality was 15.0% (6/40) within 100 days and 35.0% (14/40) within 1 year. The main causes of mortality were pneumonia and severe acute GVHD. Two-year overall survival (OS) or disease-free survival was 58.8% and 58.8%, respectively. Two-year OS for patients with advanced or complete remission disease was 48.6% and 63.8%, respectively.
  
  
  CONCLUSIONS
  The TBI/Ara-c/CY myeloablative conditioning regimen is well-tolerated and capable of establishing sustained donor cell engraftment and decreasing the risks of transplant-related death in adults with hematologic malignancies. For the high-risk and advanced patients, it may reduce the occurrences of relapse and chronic GVHD.
authors.affiliation: Department of Hematology, Affiliated Provincial Hospital, Anhui Medical University, Hefei 230001, China. zmsun2003@yahoo.com.cn
authors.forename: Zi-min
authors.initials: ZM
authors.lastname: Sun
authors.forename: Hui-lan
authors.initials: HL
authors.lastname: Liu
authors.forename: Liang-quan
authors.initials: LQ
authors.lastname: Geng
authors.forename: Chen-yang
authors.initials: CY
authors.lastname: Zhou
authors.forename: Xing-bing
authors.initials: XB
authors.lastname: Wang
authors.forename: Kai-yang
authors.initials: KY
authors.lastname: Ding
authors.forename: Juan
authors.initials: J
authors.lastname: Tong
authors.forename: Wei-bo
authors.initials: WB
authors.lastname: Zhu
authors.forename: Xin
authors.initials: X
authors.lastname: Liu
authors.forename: Zu-yi
authors.initials: ZY
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000601:surgery*; D006801:Humans; D007938:Leukemia / Q000601:surgery; D008297:Male; D019172:Transplantation Conditioning / Q000379:methods*; D014916:Whole-Body Irradiation; D055815:Young Adult