title: A prospective investigation of cell dose in single-unit umbilical cord blood transplantation for adults with high-risk hematologic malignancies.
abstract: Umbilical cord blood (UCB) as an allogeneic transplant source is generally limited to units with pre-cryopreservation total nucleated cell (TNC) doses ⩾2.5 × 10(7) NC/kg. We prospectively investigated single UCB transplantation, with cord units as low as 1 × 10(7) NC/kg, all processed with post-thaw albumin-dextran dilution. We transplanted 104 adult patients with 84% having relapsed/refractory disease. The median TNC dose was 2.1 × 10(7) NC/kg (range: 1.0-4.4 × 10(7)) and median CD34+ cell dose was 1.0 × 10(5)/kg (range: 0.0-3.7 × 10(5)/kg). Post-manipulation cell recovery and viability were 96% and 99%, respectively. Median times to neutrophil and platelet engraftment were 16 and 43 days, respectively. Univariate factors predicting neutrophil engraftment included TNC (P=0.03) and CD34+ cell dose (P=0.01). CD34+ dose predicted platelet engraftment (P<0.001). In multivariate analysis, CD34+ dose remained significant for neutrophil and platelet engraftment (P<0.0001 and P<0.0001, respectively). The 100-day and 1-year overall survival were 70% and 46%, respectively (95% confidence interval: 36%-56% at 1 year). The subset transplanted with 1-1.5 × 10(7) NC/kg had similar 100-day and 1-year survivals of 73% and 45%, respectively. Single-unit UCB transplantation using small units, processed as described, leads to favorable engraftment and acceptable outcomes in poor prognosis patients. CD34+ cell dose (⩾1.5 × 10(5)/kg) helps predict faster engraftment and can aid in graft selection.
authors.affiliation: Loyola University Medical Center, Cardinal Bernardin Cancer Center, Maywood, IL, USA.
authors.forename: U
authors.initials: U
authors.lastname: Sobol
authors.affiliation: Loyola University Medical Center, Cardinal Bernardin Cancer Center, Maywood, IL, USA.
authors.forename: A
authors.initials: A
authors.lastname: Go
authors.affiliation: Loyola University Medical Center, Cardinal Bernardin Cancer Center, Maywood, IL, USA.
authors.forename: S
authors.initials: S
authors.lastname: Kliethermes
authors.affiliation: Loyola University Medical Center, Cardinal Bernardin Cancer Center, Maywood, IL, USA.
authors.forename: S
authors.initials: S
authors.lastname: Bufalino
authors.affiliation: Loyola University Medical Center, Cardinal Bernardin Cancer Center, Maywood, IL, USA.
authors.forename: T
authors.identifier: http://orcid.org/0000-0002-9934-9549
authors.initials: T
authors.lastname: Rodriguez
authors.affiliation: Loyola University Medical Center, Cardinal Bernardin Cancer Center, Maywood, IL, USA.
authors.forename: S
authors.initials: S
authors.lastname: Smith
authors.affiliation: Loyola University Medical Center, Cardinal Bernardin Cancer Center, Maywood, IL, USA.
authors.forename: M
authors.initials: M
authors.lastname: Parthasarathy
authors.affiliation: Loyola University Medical Center, Cardinal Bernardin Cancer Center, Maywood, IL, USA.
authors.forename: P
authors.initials: P
authors.lastname: Stiff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D019337:Hematologic Neoplasms / Q000097:blood* / Q000628:therapy*; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011446:Prospective Studies; D020127:Recovery of Function