title: Haplo-cord transplantation using CD34+ cells from a third-party donor to speed engraftment in high-risk patients with hematologic disorders.
abstract: Among the strategies to optimize engraftment of cord blood (CB) stem cell transplantation (SCT), single CB with the coinfusion of CD34(+) stem cells from an HLA-mismatched auxiliary donor (haplo-cord) provides a valid alternative for adult patients without a suitable donor. A total of 132 high-risk adult patients with hematological malignancies from 3 Spanish institutions underwent myeloablative haplo-cord SCT. The median age was 37 years and median weight was 70 kg; 37% had active disease. The median number of postprocessing CB total nucleated and CD34(+) cells was 2.4 × 10(7)/kg (interquartile range [IQR], 1.8 to 2.9) and 1.4 × 10(5)/kg (IQR, .9 to 2), respectively. Neutrophil engraftment occurred in a median of 11.5 days (IQR, 10.5 to 16.5) and platelet engraftment at 36 days (IQR, 25.5 to 77). Graft failure was 2% overall and only 9% for CB. Cumulative incidence of acute graft-versus-host disease (GHVD) grades II to IV was 21% and cumulative incidence of chronic GVHD was 21%. Median follow-up was 60 months (range, 3.5 to 163). Overall survival was 43.5%, event-free survival was 38.3%, nonrelapse mortality was 35%, and relapse was 20% at 5 years. Myeloablative haplo-cord SCT results in fast engraftment of neutrophils and platelets, low incidences of acute and chronic GVHD, and favorable long-term outcomes using single CB units with relatively low cell content. Moreover, CB cell dose had no impact on CB engraftment and survival in this study. Therefore, haplo-cord SCT expands donor availability while reducing CB cell dose requirements.
authors.affiliation: Department of Hematology, Gregorio Marañón Institute of Health Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: mi.kwon@salud.madrid.org.
authors.forename: Mi
authors.initials: M
authors.lastname: Kwon
authors.affiliation: Department of Hematology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
authors.forename: Guiomar
authors.initials: G
authors.lastname: Bautista
authors.affiliation: Department of Hematology, Gregorio Marañón Institute of Health Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Pascual
authors.initials: P
authors.lastname: Balsalobre
authors.affiliation: Department of Hematology, Hospital Duran i Reynals, Catalan Institute of Oncology, Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Sánchez-Ortega
authors.affiliation: Department of Hematology, Gregorio Marañón Institute of Health Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Serrano
authors.affiliation: Department of Hematology, Gregorio Marañón Institute of Health Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Anguita
authors.affiliation: Department of Hematology, Gregorio Marañón Institute of Health Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Ismael
authors.initials: I
authors.lastname: Buño
authors.affiliation: Department of Hematology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Fores
authors.affiliation: Department of Hematology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Regidor
authors.affiliation: Department of Hematology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: García Marco
authors.affiliation: Department of Immunology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Vilches
authors.affiliation: Department of Immunology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: de Pablo
authors.affiliation: School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Manuel N
authors.initials: MN
authors.lastname: Fernández
authors.affiliation: Department of Hematology, Gregorio Marañón Institute of Health Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Gayoso
authors.affiliation: Department of Hematology, Hospital Duran i Reynals, Catalan Institute of Oncology, Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Duarte
authors.affiliation: Department of Hematology, Gregorio Marañón Institute of Health Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Díez-Martín
authors.affiliation: Department of Hematology, Hospital Universitario Puerta de Hierro, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Cabrera
mesh_terms: D000328:Adult; D018952:Antigens, CD34; D036101:Cord Blood Stem Cell Transplantation; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013234:Stem Cells; D015996:Survival Rate; D013997:Time Factors
chemical_list: D018952:Antigens, CD34
keywords: Alternative donor; Cord blood transplantation; Haploidentical