title: Cord-blood engraftment with ex vivo mesenchymal-cell coculture.
abstract: BACKGROUND
  Poor engraftment due to low cell doses restricts the usefulness of umbilical-cord-blood transplantation. We hypothesized that engraftment would be improved by transplanting cord blood that was expanded ex vivo with mesenchymal stromal cells.
  
  
  METHODS
  We studied engraftment results in 31 adults with hematologic cancers who received transplants of 2 cord-blood units, 1 of which contained cord blood that was expanded ex vivo in cocultures with allogeneic mesenchymal stromal cells. The results in these patients were compared with those in 80 historical controls who received 2 units of unmanipulated cord blood.
  
  
  RESULTS
  Coculture with mesenchymal stromal cells led to an expansion of total nucleated cells by a median factor of 12.2 and of CD34+ cells by a median factor of 30.1. With transplantation of 1 unit each of expanded and unmanipulated cord blood, patients received a median of 8.34×10(7) total nucleated cells per kilogram of body weight and 1.81×10(6) CD34+ cells per kilogram--doses higher than in our previous transplantations of 2 units of unmanipulated cord blood. In patients in whom engraftment occurred, the median time to neutrophil engraftment was 15 days in the recipients of expanded cord blood, as compared with 24 days in controls who received unmanipulated cord blood only (P<0.001); the median time to platelet engraftment was 42 days and 49 days, respectively (P=0.03). On day 26, the cumulative incidence of neutrophil engraftment was 88% with expansion versus 53% without expansion (P<0.001); on day 60, the cumulative incidence of platelet engraftment was 71% and 31%, respectively (P<0.001).
  
  
  CONCLUSIONS
  Transplantation of cord-blood cells expanded with mesenchymal stromal cells appeared to be safe and effective. Expanded cord blood in combination with unmanipulated cord blood significantly improved engraftment, as compared with unmanipulated cord blood only. (Funded by the National Cancer Institute and others; ClinicalTrials.gov number, NCT00498316.).
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, University of Texas M.D. Anderson Cancer Center, Houston, USA. marcos.delima@uhhospitals.org
authors.forename: Marcos
authors.initials: M
authors.lastname: de Lima
authors.forename: Ian
authors.initials: I
authors.lastname: McNiece
authors.forename: Simon N
authors.initials: SN
authors.lastname: Robinson
authors.forename: Mark
authors.initials: M
authors.lastname: Munsell
authors.forename: Mary
authors.initials: M
authors.lastname: Eapen
authors.forename: Mary
authors.initials: M
authors.lastname: Horowitz
authors.forename: Amin
authors.initials: A
authors.lastname: Alousi
authors.forename: Rima
authors.initials: R
authors.lastname: Saliba
authors.forename: John D
authors.initials: JD
authors.lastname: McMannis
authors.forename: Indreshpal
authors.initials: I
authors.lastname: Kaur
authors.forename: Partow
authors.initials: P
authors.lastname: Kebriaei
authors.forename: Simrit
authors.initials: S
authors.lastname: Parmar
authors.forename: Uday
authors.initials: U
authors.lastname: Popat
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.forename: Richard
authors.initials: R
authors.lastname: Champlin
authors.forename: Catherine
authors.initials: C
authors.lastname: Bollard
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Molldrem
authors.forename: Roy B
authors.initials: RB
authors.lastname: Jones
authors.forename: Yago
authors.initials: Y
authors.lastname: Nieto
authors.forename: Borje S
authors.initials: BS
authors.lastname: Andersson
authors.forename: Nina
authors.initials: N
authors.lastname: Shah
authors.forename: Betul
authors.initials: B
authors.lastname: Oran
authors.forename: Laurence J N
authors.initials: LJ
authors.lastname: Cooper
authors.forename: Laura
authors.initials: L
authors.lastname: Worth
authors.forename: Muzaffar H
authors.initials: MH
authors.lastname: Qazilbash
authors.forename: Martin
authors.initials: M
authors.lastname: Korbling
authors.forename: Gabriela
authors.initials: G
authors.lastname: Rondon
authors.forename: Stefan
authors.initials: S
authors.lastname: Ciurea
authors.forename: Doyle
authors.initials: D
authors.lastname: Bosque
authors.forename: Ila
authors.initials: I
authors.lastname: Maewal
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Simmons
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Shpall
mesh_terms: D000293:Adolescent; D000328:Adult; D001772:Blood Cell Count; D001792:Blood Platelets; D002423:Cause of Death; D018929:Cell Culture Techniques; D036101:Cord Blood Stem Cell Transplantation; D006082:Graft Enhancement, Immunologic; D006086:Graft vs Host Disease; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D045164:Mesenchymal Stem Cell Transplantation; D059630:Mesenchymal Stem Cells; D008875:Middle Aged; D009504:Neutrophils; D018183:Transplantation Chimera; D014184:Transplantation, Homologous; D055815:Young Adult