title: Umbilical cord blood transplantation in adults with advanced hodgkin's disease: high incidence of post-transplant lymphoproliferative disease.
abstract: We report the outcome of 30 consecutive patients with Hodgkin disease (HD) who underwent single-unit UCBT. Most (90%) patients had failed previous autologous hematopoietic stem cell transplantation. The conditioning regimens were based on combinations of thiotepa, busulfan, cyclophosphamide or fludarabine, and antithymocyte globulin. The cumulative incidence (CI) of myeloid engraftment was 90% [95% confidence interval (C.I.), 74-98%] with a median of 18 d (range, 10-48). CI of acute graft-versus-host disease (GvHD) grades II-IV was 30% (95% C.I., 17-44%), while the incidence of chronic GVHD was 42% (95% C.I., 23-77%). The non-relapse mortality (NRM) at 100 d and 4 yr was 30% (95% C.I., 13-46%) and 47% (95% C.I., 29-65%), respectively. EBV-related post-transplant lymphoproliferative disease (EBV-PTLD) accounted for more than one-third of transplant-related death, with an estimate incidence of 26% (95% C.I., 9-44). The incidence of relapse at 4 yr was 25% (95% C.I., 9-42%). Four-year event-free survival (EFS) and overall survival (OS) were 28% and 30%, respectively. Despite a high NRM and an unexpected high incidence of EBV-PTLD, UCBT in heavily pretreated HD patients is an option for patients lacking a suitable adult donor, provided the disease is not in refractory relapse.
authors.affiliation: Department of Hematology, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Piñana
authors.affiliation: Department of Hematology, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Sanz
authors.affiliation: Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Esquirol
authors.affiliation: Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.affiliation: Rome Transplant Network, UOC Trapianto di Cellule Staminali, Università di Roma Tor Vergata, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Picardi
authors.affiliation: Department of Hematology, Hospital Universitari Vall D'Hebron, Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Barba
authors.affiliation: Department of Clinical Hematology, Hospital Virgen del Rocio, Sevilla, Spain.
authors.forename: Rocio
authors.initials: R
authors.lastname: Parody
authors.affiliation: Department of Hematology, Hospital Gregorio Marañon, Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Gayoso
authors.affiliation: Department of Hematology, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Pau
authors.initials: P
authors.lastname: Montesinos
authors.affiliation: Bone Marrow Transplant Unit, Department of Hematology, AOU Careggi, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Guidi
authors.affiliation: Department of Hematology, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain.
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Terol
authors.affiliation: Department of Hematology, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Moscardó
authors.affiliation: Department of Hematology, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Solano
authors.affiliation: Rome Transplant Network, UOC Trapianto di Cellule Staminali, Università di Roma Tor Vergata, Rome, Italy.
authors.forename: William
authors.initials: W
authors.lastname: Arcese
authors.affiliation: Department of Hematology, Hospital Universitario La Fe, Valencia, Spain.|Medicine Department, Universitat de Valencia, Valencia, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Sanz
authors.affiliation: Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.|Hospital de la Santa Creu i Sant Pau, IIB Sant Pau and Jose Carreras Leukemia Research Institute, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Sierra
authors.affiliation: Department of Hematology, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Sanz
mesh_terms: D000208:Acute Disease; D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D002066:Busulfan / Q000627:therapeutic use; D002908:Chronic Disease; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000517:prevention & control; D004854:Herpesvirus 4, Human / Q000472:pathogenicity; D006689:Hodgkin Disease / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007244:Infectious Mononucleosis / Q000209:etiology* / Q000276:immunology / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D012008:Recurrence; D016019:Survival Analysis; D013852:Thiotepa / Q000627:therapeutic use; D019172:Transplantation Conditioning; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000961:Antilymphocyte Serum; D019653:Myeloablative Agonists; D003520:Cyclophosphamide; D013852:Thiotepa; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine
keywords: EBV post-transplant lymphoproliferative disease; Hodgkin's disease; Hodgkin's lymphoma; umbilical cord blood transplantation