title: A novel reduced-intensity conditioning regimen induces a high incidence of sustained donor-derived neutrophil and platelet engraftment after double-unit cord blood transplantation.
abstract: A preparative regimen of reduced intensity that can reliably engraft cord blood (CB) and can be used as an alternative to either high-dose myeloablative or nonmyeloablative conditioning is needed. We evaluated double-unit CB transplantation in 30 patients (median age, 56 years; range, 18 to 69) with acute leukemia or myelodysplasia using a regimen of cyclophosphamide 50 mg/kg, fludarabine 150 mg/m(2), thiotepa 10 mg/kg, and 400 cGy total body irradiation with cyclosporine-A/mycophenolate mofetil immunosuppression. Ninety-seven percent of patients engrafted at a median of 26 days (range, 13 to 43), and 93% of patients had recovered platelets by day 180. Grades II to IV acute graft-versus-host disease (GVHD) incidence was 67% at day 180, and chronic GVHD was 10% at 1 year. Transplant-related mortality was 20% at day 180, and relapse was 11% at 2 years. Overall, 2-year disease-free survival (DFS) was 60% at 2 years. A hierarchy in DFS was seen according to the Sorror comorbidity score: 11 patients (median age, 55 years) with a score of 1 had a 2-year DFS of 82% compared with 62% in 9 patients (median age, 51 years) with a score of 2 to 3 and 40% in 11 patients (median age, 58 years) with a score of 4 to 5 (P = .13). This reduced-intensity regimen combined with double-unit CB transplantation reliably facilitates sustained donor engraftment without antithymocyte globulin. Although other approaches are needed in patients with high comorbidity scores, this regimen is highly effective in patients ≥50 years old who are otherwise reasonably fit. It also represents a promising alternative to high-dose conditioning in younger patients.
authors: Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors: Doris M
authors: DM
authors: Ponce
authors: Craig
authors: C
authors: Sauter
authors: Sean
authors: S
authors: Devlin
authors: Marissa
authors: M
authors: Lubin
authors: Anne Marie
authors: AM
authors: Gonzales
authors: Nancy A
authors: NA
authors: Kernan
authors: Andromachi
authors: A
authors: Scaradavou
authors: Sergio
authors: S
authors: Giralt
authors: Jenna D
authors: JD
authors: Goldberg
authors: Guenther
authors: G
authors: Koehne
authors: Miguel A
authors: MA
authors: Perales
authors: James W
authors: JW
authors: Young
authors: Hugo
authors: H
authors: Castro-Malaspina
authors: Ann
authors: A
authors: Jakubowski
authors: Esperanza B
authors: EB
authors: Papadopoulos
authors: Juliet N
authors: JN
authors: Barker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001792:Blood Platelets / Q000166:cytology*; D015897:Comorbidity; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D018572:Disease-Free Survival; D005260:Female; D019337:Hematologic Neoplasms / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology*; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000009:adverse effects*; D055815:Young Adult