title: Dominant unit CD34+ cell dose predicts engraftment after double-unit cord blood transplantation and is influenced by bank practice.
abstract: We investigated the unit characteristics associated with engraftment after double-unit cord blood (CB) transplantation (dCBT) and whether these could be reliably identified during unit selection. Cumulative incidence of neutrophil engraftment in 129 myeloablative dCBT recipients was 95% (95% confidence interval: 90-98%). When precryopreservation characteristics were analyzed, the dominant unit CD34(+) cell dose was the only characteristic independently associated with engraftment (hazard ratio, 1.43; P = .002). When postthaw characteristics were also included, only dominant unit infused viable CD34(+) cell dose independently predicted engraftment (hazard ratio, 1.95; P < .001). We then examined the determinants of infused viable CD34(+) cell dose (precryopreservation count, postthaw recovery, and postthaw viability) in 402 units thawed at our center. This revealed close correlation between precryopreservation and postthaw CD34(+) cell counts (r(2) = 0.73). Median CD34(+) cell recovery was 101%, although it ranged from 12% to 1480%. Notably, units from non-Netcord Foundation for the Accreditation of Cellular Therapy (Netcord-FACT)-accredited banks were more likely to have low recovery (P < .001). Furthermore, although median postthaw CD34(+) cell viability was 92%, 33 (8%) units had <75% viable CD34(+) cells. Units from non-Netcord-FACT-accredited banks and units with cryovolumes other than 24.5 to 26.0 mL were more likely to have poor postthaw viability. Precryopreservation CD34(+) cell dose and banking practices should be incorporated into CB unit selection.
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine.
authors.forename: Duncan
authors.initials: D
authors.lastname: Purtill
authors.affiliation: Department of Laboratory Medicine.
authors.forename: Katherine
authors.initials: K
authors.lastname: Smith
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY;
authors.forename: Sean
authors.initials: S
authors.lastname: Devlin
authors.affiliation: Department of Laboratory Medicine.
authors.forename: Richard
authors.initials: R
authors.lastname: Meagher
authors.affiliation: Department of Laboratory Medicine.
authors.forename: Joann
authors.initials: J
authors.lastname: Tonon
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine.
authors.forename: Marissa
authors.initials: M
authors.lastname: Lubin
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine, Weill Cornell Medical College, New York, NY; and.
authors.forename: Doris M
authors.initials: DM
authors.lastname: Ponce
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine, Weill Cornell Medical College, New York, NY; and.
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, NY.
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, NY.
authors.forename: Andromachi
authors.initials: A
authors.lastname: Scaradavou
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine.
authors.forename: Cladd E
authors.initials: CE
authors.lastname: Stevens
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine, Weill Cornell Medical College, New York, NY; and.
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Barker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D000094902:Blood Banking / Q000379:methods*; D001793:Blood Preservation / Q000379:methods; D002469:Cell Separation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D015925:Cryopreservation / Q000379:methods; D006085:Graft Survival; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007223:Infant; D008875:Middle Aged; D009504:Neutrophils / Q000637:transplantation*; D055815:Young Adult
chemical_list: D018952:Antigens, CD34; D015415:Biomarkers