title: A novel reduced-intensity umbilical cord blood transplantation using a recombinant G-CSF combined with high-dose Ara-C for active myeloid malignancies.
abstract: Non-remitting patients with hematologic myeloid malignancies have poor prognosis. To overcome this problem, we investigated the use of reduced-intensity preconditioning umbilical cord blood transplantation (RICBT) combined with recombinant G-CSF (rG-CSF) with high-dose Ara-C, fludarabine, melphalan, and 4 Gy of TBI in a phase I/II study in patients with non-remitting myeloid hematologic malignancies. Thirteen patients were enrolled, including 12 with non-remitting AML and one patient with blastic crisis CML (CML-BC). The patients' median age was 45 years, with a median comorbidity index of 4. All patients received 4/6 serological HLA-antigen matched unrelated umbilical cord blood. All patients were engrafted within 30 days after RICBT (median, 20 days; range, 14-29) and achieved complete remission without prior hematopoiesis. Common grade III non-hematologic toxicities included eight cases of transient mucositis (62%) and six cases of febrile neutropenia (46%). Transplant-related mortality was 7.7%. The 1-year overall survival was 28.6% in cases without post-RICBT treatment and 83.3% in cases with post-RICBT treatment. These data suggest that in active AML and CML-BC, the combination of rG-CSF with high-dose Ara-C and fludarabine/melphalan/4 Gy TBI with a reduced-intensity preconditioning regimen is well tolerated, secures engraftment and has significant anti-leukemia activity. In addition, performing post-RICBT treatment may provide high-quality long-term survival and remission.
authors.affiliation: Division of Hematology, The First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Gotoh
authors.affiliation: Division of Hematology, The First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Yoshizawa
authors.affiliation: Division of Hematology, The First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Katagiri
authors.affiliation: Division of Hematology, The First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Suguro
authors.affiliation: Division of Hematology, The First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Asano
authors.affiliation: Division of Hematology, The First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kitahara
authors.affiliation: Division of Hematology, The First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: D
authors.initials: D
authors.lastname: Akahane
authors.affiliation: Division of Hematology, The First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Okabe
authors.affiliation: Division of Hematology, The First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Tauchi
authors.affiliation: Division of Hematology, The First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Division of Hematology, The First Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ohyashiki
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D003561:Cytarabine / Q000627:therapeutic use*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D019337:Hematologic Neoplasms / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine; D016179:Granulocyte Colony-Stimulating Factor
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