title: "No wash" albumin-dextran dilution for double-unit cord blood transplantation is safe with high rates of sustained donor engraftment.
abstract: Washing cord blood (CB) grafts involves product manipulation and may result in cell loss. We investigated double-unit CB transplantation (CBT) using red blood cell (RBC)-depleted units diluted with albumin-dextran in patients with hematologic malignancies. One-hundred thirty-six patients (median age, 43 years; range, 4 to 71; median weight, 69 kilograms (kg); range, 24 to 111) underwent transplantation with a 4/6 to 6/6 HLA-matched graft. Patients ≤ 20 kg were excluded, as they only received washed units. Units were diluted a median of 8 fold to a median volume of 200 mL/unit. The median infused total nucleated cell doses were 2.7 (larger unit) and 2.0 (smaller unit) x 10(7)/kg, respectively, and the median post-thaw recovery was 86%. Units were infused consecutively (median, 45 minutes/unit). While only 17 patients (13%) had no infusion reactions, reactions in the remaining 119 patients were almost exclusively mild-moderate (by CTCAE v4 criteria 12 grade 1, 43 grade 2, 63 grade 3) with only 1 patient (< 1%) having a severe (grade 4) reaction. Moreover, most were easily treated. Grade 2 to 3 hypertension was the most common in 101 (74%) patients. The cumulative incidence of sustained donor-derived neutrophil engraftment was high: 95% in myeloablative and 94% in nonmyeloablative CBT recipients. With appropriate supportive care, double-unit CBT with RBC-depleted grafts infused after albumin-dextran dilution is safe with high rates of engraftment in patients > 20 kg.
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Weill Cornell Medical College of Cornell University, New York, New York.
authors.forename: Parastoo B
authors.initials: PB
authors.lastname: Dahi
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Weill Cornell Medical College of Cornell University, New York, New York.
authors.forename: Doris M
authors.initials: DM
authors.lastname: Ponce
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Sean
authors.initials: S
authors.lastname: Devlin
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Evans
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Marissa N
authors.initials: MN
authors.lastname: Lubin
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Gonzales
authors.affiliation: Department of Clinical Laboratories, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Joann
authors.initials: J
authors.lastname: Tonon
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Clinical Laboratories, Memorial Sloan-Kettering Cancer Center, New York, New York; Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Meagher
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Weill Cornell Medical College of Cornell University, New York, New York.
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.affiliation: Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Kernan
authors.affiliation: Bone Marrow Transplantation Service, Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Andromachi
authors.initials: A
authors.lastname: Scaradavou
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, New York; Weill Cornell Medical College of Cornell University, New York, New York. Electronic address: barkerj@mskcc.org.
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Barker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D003911:Dextrans / Q000008:administration & dosage; D005260:Female; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology; D019337:Hematologic Neoplasms / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D014677:Pharmaceutical Vehicles / Q000008:administration & dosage; D012189:Retrospective Studies; D012709:Serum Albumin / Q000008:administration & dosage; D019172:Transplantation Conditioning; D016896:Treatment Outcome
chemical_list: D003911:Dextrans; D006680:HLA Antigens; D019653:Myeloablative Agonists; D014677:Pharmaceutical Vehicles; D012709:Serum Albumin
keywords: Cord blood transplantation; Engraftment; Infusion reactions