title: Double umbilical cord blood transplantation in patients with hematologic malignancies using a reduced-intensity preparative regimen without antithymocyte globulin.
abstract: Reduced-intensity conditioning (RIC) regimens in cord blood transplant (CBT) are increasingly utilized for older patients and those with comorbidities. However, the optimal conditioning regimen has not yet been established and remains a significant challenge of this therapeutic approach. Antithymocyte globulin (ATG) has been incorporated into conditioning regimens in order to decrease the risk of graft failure; however, use of ATG is often associated with infusion reactions and risk of post-transplant complications. We report the results of a non-ATG-containing RIC regimen, where patients received 2 Gy TBI unless they were considered to be at higher risk of graft failure, in which case they received 3 Gy of TBI. Thirty patients underwent CBT using this protocol for high-risk hematological malignancies. There was only one case of secondary and no cases of primary graft failure. At 1 year, estimates of non-relapse mortality, OS and PFS were 29%, 53% and 45%, respectively. The cumulative incidences of grade III-IV acute and chronic GVHD were 14% and 18%, respectively. In summary, the results of this study demonstrate that this non-ATG-containing conditioning regimen provides a low incidence of graft failure without increasing regimen-related toxicity.
authors.affiliation: Clinical Oncology Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
authors.forename: F
authors.initials: F
authors.lastname: Ostronoff
authors.forename: F
authors.initials: F
authors.lastname: Milano
authors.forename: T
authors.initials: T
authors.lastname: Gooley
authors.forename: J A
authors.initials: JA
authors.lastname: Gutman
authors.forename: P
authors.initials: P
authors.lastname: McSweeney
authors.forename: F B
authors.initials: FB
authors.lastname: Petersen
authors.forename: B M
authors.initials: BM
authors.lastname: Sandmaier
authors.forename: R
authors.initials: R
authors.lastname: Storb
authors.forename: C
authors.initials: C
authors.lastname: Delaney
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum; D002908:Chronic Disease; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007155:Immunologic Factors; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019172:Transplantation Conditioning; D014916:Whole-Body Irradiation
chemical_list: D000961:Antilymphocyte Serum; D007155:Immunologic Factors