title: Unrelated cord blood transplantation: outcomes after single-unit intrabone injection compared with double-unit intravenous injection in patients with hematological malignancies.
abstract: BACKGROUND
  Unrelated cord blood transplantation (UCBT) is associated with delayed hematopoietic recovery. Intrabone injection of cord blood cells (IB-UCBT) and double-UCBT (dUCBT) are designed to circumvent this problem.
  
  
  METHODS
  In a retrospective registry-based analysis, we compared outcomes of 87 IB-UCBT with 149 dUCBT recipients, after myeloablative conditioning regimen adjusting for the differences between the two groups. Median-infused total nucleated cells were 2.5×10/kg for IB-UCBT and 3.9×10/kg for dUCBT (P<0.001).
  
  
  RESULTS
  At day +30, cumulative incidence (CI) of neutrophil recovery was 76% and 62% (P=0.014) with a median time to engraftment of 23 and 28 days (P=0.001), after IB-UCBT and dUCBT, respectively. At day +180, CI of platelets recovery was 74% after IB-UCBT, and 64%, after dUCBT (P=0.003). In multivariate analysis, IB-UCBT was associated with neutrophil and platelets recovery and lower acute graft versus host disease (II-IV) (P<0.01). At 2 years, CI of nonrelapse mortality and relapse incidence were 30% and 25% after IB-UCBT and 34% and 29% after dUCBT, and disease-free survival was 45% and 37%, respectively. However, after landmark analysis at 4.7 months from transplantation, in multivariate analysis, relapse incidence was reduced (P=0.03), and there was a trend for better disease-free survival after IB-UCBT (P=0.09).
  
  
  CONCLUSIONS
  Both approaches expand the possibility of offering UCBT to patients with hematopoietic malignancies; IB-UCBT is associated with faster myeloid and platelet recovery and lower acute graft versus host disease and may reduce the total cost. However, studies on cost effectiveness are needed to compare both strategies.
authors.affiliation: EUROCORD, EUROCORD-ED, Hôpital Saint Louis, Assistance publique des hôpitaux de Paris, Paris, France. vanderson.rocha@ouh.nhs.uk
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.forename: Annalisa
authors.initials: A
authors.lastname: Ruggeri
authors.forename: Marina
authors.initials: M
authors.lastname: Podestà
authors.forename: Andrea
authors.initials: A
authors.lastname: Gallamini
authors.forename: Francesca
authors.initials: F
authors.lastname: Bonifazi
authors.forename: Fermin M
authors.initials: FM
authors.lastname: Sanchez-Guijo
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rovira
authors.forename: Gerard
authors.initials: G
authors.lastname: Socie
authors.forename: Ioannis
authors.initials: I
authors.lastname: Baltadakis
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.forename: Eric
authors.initials: E
authors.lastname: Deconinck
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
authors.forename: Francesco
authors.initials: F
authors.lastname: Frassoni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001792:Blood Platelets / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006086:Graft vs Host Disease / Q000209:etiology; D019337:Hematologic Neoplasms / Q000097:blood / Q000601:surgery*; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D008875:Middle Aged; D009504:Neutrophils / Q000502:physiology; D012189:Retrospective Studies