title: Combined umbilical cord blood and bone marrow from HLA-identical sibling donors for hematopoietic stem cell transplantation in children with hemoglobinopathies.
abstract: BACKGROUND
  It is well established that umbilical cord blood and bone marrow are biologically different stem cell sources.
  
  
  METHODS
  We analyzed the feasibility and outcome of hematopoietic stem cell transplantation (HSCT) in 13 children (median age 5.9 years) with hemoglobinopathies after the co- infusion of cord blood (CB) and bone marrow (BM) from the same human leucocyte antigen (HLA) identical sibling donor. We also compared outcomes of children with co-transplantation to outcomes in children with hemoglobinopathies who had received a BM (n = 21) or CB (n = 22) transplant alone.
  
  
  RESULTS
  Compared to CB transplant (CBT) recipients, the co-transplant group had more rapid neutrophil (17 vs. 25 days, P = 0.013) and platelet (29 vs. 48 days, P = 0.009) recovery and less transplant related mortality. Patients who received a co-transplant had a lower incidence of ≥ grade II acute (0% vs. 26.3%) and chronic (0% vs. 21%) graft versus host disease (GVHD) compared to BM transplant (BMT) recipients (P = 0.055 and 0.045, respectively). With a median follow-up of >60 months in each treatment group, the 5-year probability of event free survival (EFS) was 100% in the co-transplant group, 90% after BMT and 86% after CBT (P = 0.42).
  
  
  CONCLUSIONS
  Co-transplantation of CB and BM from HLA-identical sibling donors appears to be a feasible and effective strategy to further optimize outcomes of HSCT for hemoglobinopathies.
authors.affiliation: Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Soni
authors.forename: Farid
authors.initials: F
authors.lastname: Boulad
authors.forename: Morton J
authors.initials: MJ
authors.lastname: Cowan
authors.forename: Andromachi
authors.initials: A
authors.lastname: Scaradavou
authors.forename: Jueeli
authors.initials: J
authors.lastname: Dahake
authors.forename: Sandie
authors.initials: S
authors.lastname: Edwards
authors.forename: Mark C
authors.initials: MC
authors.lastname: Walters
mesh_terms: D000293:Adolescent; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation; D006453:Hemoglobinopathies / Q000401:mortality / Q000628:therapy*; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D015996:Survival Rate
chemical_list: D006680:HLA Antigens
keywords: bone marrow transplant; cord blood transplant; hemoglobinopathy; sickle cell disease; thalassemia