title: Severe infections after single umbilical cord blood transplantation in adults with or without the co-infusion of CD34+ cells from a third-party donor: results of a multicenter study from the Grupo Español de Trasplante Hematopoyético (GETH).
abstract: BACKGROUND
  Umbilical cord blood transplantation (CBT) is an established alternative source of stem cells in the setting of unrelated transplantation. When compared with other sources, single-unit CBT (sCBT) is associated with a delayed hematologic recovery, which may lead to a higher infection-related mortality (IRM). Co-infusion with the sCBT of CD34+ peripheral blood stem cells from a third-party donor (TPD) (sCBT + TPDCD34+) has been shown to markedly accelerate leukocyte recovery, potentially reducing the IRM. However, to our knowledge, no comparative studies have focused on severe infections and IRM with these 2 sCBT strategies.
  
  
  METHODS
  A total of 148 consecutive sCBT (2000-2010, median follow-up 4.5 years) were included in a multicenter retrospective study to analyze the incidence and risk factors of IRM and severe viral and invasive fungal infections (IFIs). Neutrophil engraftment occurred in 90% of sCBT (n = 77) and 94% sCBT + TPDCD34+ (n = 71) recipients at a median of 23 and 12 days post transplantation, respectively (P < 0.01).
  
  
  RESULTS
  The 4-year IRM was 24% and 20%, respectively (P = 0.7), with no differences at day +30 (5% and 4%, respectively) and day +100 (10% and 8%, respectively). In multivariate analysis early status of the underlying malignancy, cytomegalovirus (CMV)-seronegative recipient and high CD34+ cell content in the cord blood unit before cryostorage (≥1.4 × 10(5) /kg) were protective of IRM. Among the causes of IRM, bacterial infections and IFIs were more common in sCBT (15% vs. 4%), while CMV disease and parasitic infections were more common in the sCBT + TPDCD34+ cohort (5% vs. 16%).
  
  
  CONCLUSIONS
  These data show that sCBT supported with TPDCD34(+) cells results in much shorter periods of post-transplant leukopenia, but the short- and long-term rates of IRM were comparable to those of sCBT, presumably because immune recovery is equally delayed in both graft types.
authors: Clinical Hematology Service, Hospital de la Santa Creu i Sant Pau, José Carreras Leukemia Research Institute, Barcelona, Spain.
authors: R
authors: R
authors: Martino
authors: G
authors: G
authors: Bautista
authors: R
authors: R
authors: Parody
authors: I
authors: I
authors: García
authors: A
authors: A
authors: Esquirol
authors: M
authors: M
authors: Rovira
authors: J R
authors: JR
authors: Cabrera
authors: C
authors: C
authors: Regidor
authors: R
authors: R
authors: Fores
authors: J A
authors: JA
authors: García-Marco
authors: D
authors: D
authors: Serrano
authors: P
authors: P
authors: Barba
authors: I
authors: I
authors: Heras
authors: F J
authors: FJ
authors: Marquez-Malaver
authors: I
authors: I
authors: Sánchez-Ortega
authors: R
authors: R
authors: Duarte
authors: S
authors: S
authors: Saavedra
authors: J
authors: J
authors: Sierra
authors: L
authors: L
authors: Vazquez
mesh_terms: D000293:Adolescent; D000328:Adult; D018952:Antigens, CD34; D001424:Bacterial Infections / Q000453:epidemiology* / Q000401:mortality; D002066:Busulfan / Q000627:therapeutic use; D015331:Cohort Studies; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007938:Leukemia / Q000628:therapy*; D008223:Lymphoma / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009181:Mycoses / Q000453:epidemiology* / Q000401:mortality; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013852:Thiotepa / Q000627:therapeutic use; D019172:Transplantation Conditioning / Q000379:methods; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014777:Virus Diseases / Q000453:epidemiology* / Q000401:mortality; D014916:Whole-Body Irradiation; D055815:Young Adult
chemical_list: D018952:Antigens, CD34; D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists; D016179:Granulocyte Colony-Stimulating Factor; D016572:Cyclosporine; D013852:Thiotepa; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine
keywords: allogeneic; cord blood transplantation; severe infections