title: Double-unit cord blood transplantation after myeloablative conditioning for patients with hematologic malignancies: a multicenter phase II study in Japan.
abstract: We analyzed the outcomes of 61 patients with hematologic malignancies who underwent double-unit cord blood transplantation (dCBT) after myeloablative conditioning performed as part of a prospective multicenter phase II study. The conditioning regimen for dCBT included total body irradiation, cyclophosphamide, and granulocyte colony-stimulating factor combined with cytosine arabinoside for myeloid malignancies and with total body irradiation and cyclophosphamide for lymphoid malignancies. The cumulative incidence of neutrophil engraftment after dCBT was 85% (95% confidence interval [CI], 73%-92%). All 51 of the patients who engrafted had complete chimerism derived from a single donor by day +60. Only the degree of HLA disparity in the host-versus-graft direction had an impact on unit dominance. The cumulative incidence of grade II-IV acute graft-versus-host disease was 25% (95% CI, 15%-37%), and that of chronic graft-versus-host disease was 32% (95% CI, 20%-44%). The 1-year cumulative incidence of relapse was 23% (95% CI, 13%-34%), and that of transplantation-related mortality was 28% (95% CI, 17%-39%). With a median follow-up of 41 months, event-free survival was 48% (90% CI, 37%-58%) at 1 year and 46% (90% CI, 35%-56%) at 3 years. Event-free survival at 3 years was 67% (95% CI, 46%-81%) for patients with standard risk and 29% (95% CI, 15%-45%) for those with advanced risk. This study suggests that dCBT after myeloablative conditioning is a promising alternative for adults and large children with hematologic malignancies who need stem cell transplantation but lack a suitable adult donor or an adequate single-unit cord blood graft.
authors: Department of Transfusion Medicine, Hyogo College of Medicine, Nishinomiya, Japan. kai@hyo-med.ac.jp
authors: Shunro
authors: S
authors: Kai
authors: Atsushi
authors: A
authors: Wake
authors: Masaya
authors: M
authors: Okada
authors: Mio
authors: M
authors: Kurata
authors: Yoshiko
authors: Y
authors: Atsuta
authors: Jun
authors: J
authors: Ishikawa
authors: Hirohisa
authors: H
authors: Nakamae
authors: Nobuyuki
authors: N
authors: Aotsuka
authors: Masaharu
authors: M
authors: Kasai
authors: Mahito
authors: M
authors: Misawa
authors: Shuichi
authors: S
authors: Taniguchi
authors: Shunichi
authors: S
authors: Kato
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D005260:Female; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D019172:Transplantation Conditioning / Q000379:methods*; D055815:Young Adult