title: Single cord blood combined with HLA-mismatched third party donor cells: comparable results to matched unrelated donor transplantation in high-risk patients with hematologic disorders.
abstract: Matched unrelated donor (MUD) transplantation is the first alternative in the absence of a matched sibling donor. For patients without a suitable adult donor, we have adopted the dual stem cell transplantation protocol consisting of cord blood (CB) in combination with CD34(+) cells from a third party HLA-mismatched donor. We analyzed the outcomes of patients undergoing both procedures in a single center. Starting in 2004, a total of 20 patients with high-risk disease underwent 22 dual transplants and 25 patients underwent myeloablative MUD transplantation. The 30-day cumulative incidence of neutrophil engraftment was similar in both groups (91% and 95%), with a median time to engraftment of 14 and 16 days, respectively. Grade II-IV acute graft-versus-host disease was more frequent in the MUD group (40% versus 5%). Except for a tendency toward a higher incidence of viral hemorrhagic cystitis in the dual transplantation group, posttransplantation infectious events were comparable in the 2 groups. The 3-year cumulative incidence rates of relapse (41% versus 44%) and nonrelapse mortality (30% versus 25%) were similar in the MUD and dual transplantation cohorts. Estimated 3-year overall survival and disease-free survival were 47% and 41%, respectively, with no survival advantage for either group. In our experience, dual transplantation offers survival rates comparable to those from myeloablative MUD transplantation with similar nonrelapse mortality rates.
authors.affiliation: Gregorio Marañón Institute of Health Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain. mkwon.hgugm@salud.madrid.org
authors.forename: Mi
authors.initials: M
authors.lastname: Kwon
authors.forename: Pascual
authors.initials: P
authors.lastname: Balsalobre
authors.forename: David
authors.initials: D
authors.lastname: Serrano
authors.forename: A
authors.initials: A
authors.lastname: Pérez Corral
authors.forename: Ismael
authors.initials: I
authors.lastname: Buño
authors.forename: Javier
authors.initials: J
authors.lastname: Anguita
authors.forename: Jorge
authors.initials: J
authors.lastname: Gayoso
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Diez-Martin
mesh_terms: D000208:Acute Disease; D000328:Adult; D036101:Cord Blood Stem Cell Transplantation; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000401:mortality / Q000628:therapy; D006680:HLA Antigens; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D035781:Siblings; D015996:Survival Rate; D013997:Time Factors; D061349:Unrelated Donors
chemical_list: D006680:HLA Antigens