title: Combined cord blood and bone marrow transplantation from the same human leucocyte antigen-identical sibling donor for children with malignant and non-malignant diseases.
abstract: Umbilical cord blood (UCB) from an human leucocyte antigen (HLA)-identical sibling can be used for transplantation of patients with malignant and non-malignant diseases. However, the low cellular content of most UCB units represents a limitation to this approach. An option to increase cell dose is to harvest bone marrow (BM) cells from the same donor and infuse them along with the UCB. We studied 156 children who received such a combined graft between 1992 and 2011. Median age was 7 years and 78% of patients (n = 122) were transplanted for non-malignant diseases, mainly haemoglobinopathies. Acute leukaemia (n = 26) was the most frequent malignant diagnosis. Most patients (91%) received myeloablative conditioning. Median donor age was 1·7 years, median infused nucleated cell dose was 24·4 × 10(7) /kg and median follow-up was 41 months. Sixty-days neutrophil recovery occurred in 96% of patients at a median of 17 d. The probabilities of grade-II-IV acute and chronic graft-versus-host disease (GVHD) were 19% and 10%, respectively. Four-year overall survival was 90% (68% malignant; 97% non-malignant diseases) with 3% probability of death. In conclusion, combined UCB and BM transplantation from an HLA-identical sibling donor is an effective treatment for children with malignant and non-malignant disorders with high overall survival and low incidence of GVHD.
authors.affiliation: Hospital Saint Louis, AP-HP, and IUH University Paris VII, Eurocord, Paris, France; Centro de Oncologia, Hospital Sirio-Libanes, Sao Paulo, Brazil.
authors.forename: Luciana
authors.initials: L
authors.lastname: Tucunduva
authors.forename: Fernanda
authors.initials: F
authors.lastname: Volt
authors.forename: Renato
authors.initials: R
authors.lastname: Cunha
authors.forename: Franco
authors.initials: F
authors.lastname: Locatelli
authors.forename: Marco
authors.initials: M
authors.lastname: Zecca
authors.forename: Akif
authors.initials: A
authors.lastname: Yesilipek
authors.forename: Maurizio
authors.initials: M
authors.lastname: Caniglia
authors.forename: Tayfun
authors.initials: T
authors.lastname: Güngör
authors.forename: Serap
authors.initials: S
authors.lastname: Aksoylar
authors.forename: Franca
authors.initials: F
authors.lastname: Fagioli
authors.forename: Yves
authors.initials: Y
authors.lastname: Bertrand
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: Addari
authors.forename: Josu
authors.initials: J
authors.lastname: de la Fuente
authors.forename: Jacek
authors.initials: J
authors.lastname: Winiarski
authors.forename: Andrea
authors.initials: A
authors.lastname: Biondi
authors.forename: Henrik
authors.initials: H
authors.lastname: Sengeloev
authors.forename: Isabel
authors.initials: I
authors.lastname: Badell
authors.forename: Karin
authors.initials: K
authors.lastname: Mellgren
authors.forename: Cristina Díaz
authors.initials: CD
authors.lastname: de Heredia
authors.forename: Petr
authors.initials: P
authors.lastname: Sedlacek
authors.forename: Ajay
authors.initials: A
authors.lastname: Vora
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.forename: Annalisa
authors.initials: A
authors.lastname: Ruggeri
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D064591:Allografts; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D036101:Cord Blood Stem Cell Transplantation; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000401:mortality* / Q000628:therapy*; D019520:Living Donors; D008297:Male; D015996:Survival Rate; D019172:Transplantation Conditioning
keywords: bone marrow; cord blood; haematopoietic stem cell transplantation