title: Prospective multicenter study of single-unit cord blood transplantation with myeloablative conditioning for adult patients with high-risk hematologic malignancies.
abstract: Although the use of cord blood transplantation (CBT) is increasing, the optimal methods for conditioning and graft-versus-host disease (GVHD) prophylaxis remain to be established. Among previous reports, the Institute of Medical Science, University of Tokyo (IMSUT) has reported remarkably favorable results of CBT for hematologic malignancies as a single-institute experience. The aim of the present multicenter prospective study was to assess the safety and efficacy of CBT performed precisely according to IMSUT transplantation procedures. Thirty-three adult patients with hematologic malignancies, such as acute leukemia, chronic myelogenous leukemia, or myelodysplastic syndrome, either lacking an HLA-identical sibling/HLA-matched unrelated donor or requiring urgent transplantation were enrolled. Conditioning consisted of total body irradiation (12 Gy), cytarabine, and cyclophosphamide. Cyclosporine A and methotrexate were used for GVHD prophylaxis. Diagnoses were acute leukemia in 26 patients, chronic myelogenous leukemia in 4, and myelodysplastic syndrome in 3; 12 patients were in first complete remission, and the others were in advanced stages at the time of CBT. Thirty-one patients achieved engraftment, and the cumulative incidence of grade II-IV acute GVHD was 45% (95% confidence interval, 28%-62%). With a median follow-up of 46.2 months in 16 surviving patients, the 1-year cumulative incidence of nonrelapse mortality was 15% (95% confidence interval, 5%-30%). Causes of nonrelapse mortality were infection (n = 4) and graft failure (n = 1). The overall and disease-free survival rates were 51% (95% CI, 34%-68%) and 42% (95% CI, 26%-59%), respectively. These results suggest that the IMSUT CBT procedures can safely provide a high disease-free survival rate in patients with high-risk hematologic malignancies.
authors.affiliation: Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan. tmori@a3.keio.jp
authors.forename: Takehiko
authors.initials: T
authors.lastname: Mori
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Tanaka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Kazuteru
authors.initials: K
authors.lastname: Ohashi
authors.forename: Shin
authors.initials: S
authors.lastname: Fujisawa
authors.forename: Akira
authors.initials: A
authors.lastname: Yokota
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Fujita
authors.forename: Chiaki
authors.initials: C
authors.lastname: Nakaseko
authors.forename: Toru
authors.initials: T
authors.lastname: Sakura
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Nannya
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Heiwa
authors.initials: H
authors.lastname: Kanamori
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Okamoto
mesh_terms: D000328:Adult; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D003520:Cyclophosphamide / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D011446:Prospective Studies; D012306:Risk; D035781:Siblings; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D061349:Unrelated Donors; D014916:Whole-Body Irradiation
chemical_list: D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists; D003561:Cytarabine; D016572:Cyclosporine; D003520:Cyclophosphamide; D008727:Methotrexate