Factors with an impact on chimerism development and long-term survival after umbilical cord blood transplantation.
BACKGROUND
Umbilical cord blood transplantation (UCBT) is increasingly used and produces similar results to matched unrelated donor transplantation.


METHODS
We performed a retrospective single-center analysis of 50 umbilical cord blood transplantations UCBTs performed from 2001 to 2010, including 37 single and 13 double umbilical cord blood transplantations UCBTs.


RESULTS
The rate of engraftment of neutrophils was 88% at a median time of 29 days (range, 3-79). Complete donor chimerism (DC) within the CD19, CD3, and CD33 cell lineages was seen in 74%, 72%, and 76% of the patients, respectively. DC was associated with acute graft-versus-host disease (GVHD) grades II to IV for the CD3 cell lineage (P=0.01) and, in multivariate analysis, with total body irradiation for all lineages (P<0.01). Overall survival (OS) at 1 and 5 years was 55% and 43%. Nonmalignant diseases were associated with better 5-year OS (72%) than malignancies (28%; P=0.026). In multivariate analysis, a negative correlation was seen between OS and age (hazard ratio [HR], 1.04; 95% confidence interval [95% CI], 1.02-1.06; P<0.001), acute GVHD grades III and IV (HR, 3.43; 95% CI, 1.95-6.02; P<0.001), and mesenchymal stem cell treatment (HR, 2.66; 95% CI, 1.11-6.35; P=0.027). Transplant-related mortality at 100 days and 1 year was 16% and 30%. The incidence of acute GVHD grades II to IV was 34%. Acute GVHD grades III and IV was associated with ABO incompatibility (HR, 2.61; P=0.05) and myeloablative conditioning (HR, 4.17; P=0.047).


CONCLUSIONS
The outcome in patients with nonmalignant diseases was acceptable, but transplant-related mortality in the whole group remains high. A significantly higher rate of DC was associated with total body irradiation-based conditioning and with acute GVHD grades II and IV.
Centre for Allogeneic Stem Cell Transplantation, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden. sofia.berglund@ki.se
Sofia
S
Berglund
Katarina
K
Le Blanc
Mats
M
Remberger
Jens
J
Gertow
Mehmet
M
Uzunel
Petter
P
Svenberg
Jacek
J
Winiarski
Per
P
Ljungman
Olle
O
Ringdén
Michael
M
Uhlin
Jonas
J
Mattsson
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D018941:Antigens, CD19 / Q000378:metabolism; D017252:CD3 Complex / Q000378:metabolism; D019070:Cell Lineage; D002648:Child; D002675:Child, Preschool; D046528:Chimerism; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology / Q000473:pathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D063268:Sialic Acid Binding Ig-like Lectin 3 / Q000378:metabolism; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods*; D055815:Young Adult
D018941:Antigens, CD19; D017252:CD3 Complex; D063268:Sialic Acid Binding Ig-like Lectin 3