title: [The curative efficacy of unrelated umbilical cord blood stem cells transplantation in intensified myeloablative conditioned patients with acute lymphoblastic leukemia].
abstract: OBJECTIVE
  To retrospectively analyze the efficacy of unrelated umbilical cord blood transplantation (UCBT) with intensified myeloablative conditioning regimen in patients with acute lymphoblastic leukemia (ALL).
  
  
  METHODS
  From September 2006 to December 2013, a total of 110 consecutive patients with ALL had received UCBT, including 79 male and 31 female patients with a median age of 14(2-51) years, a median weight of 45(12-100)kg. Sixty-one cases were in the first complete remission (CR), 30, 6 and 13 patients in the second, the third CR and advanced stages respectively. The conditioning regimen consisted of total body irradiation, cyclophosphamide and cytarabine (TBI/Cy/Ara-C) in 61 patients, busulfan, cyclophosphamide and fludarabine (BU/Cy/Flu) in 39 patients and BU/Cy/Ara-C in 10 patients. All patients received a combination of cyclosporine (CsA) and mycophenolate mofetil (MMF) for the prophylaxis of graft-versus-host disease (GVHD).
  
  
  RESULTS
  The median amount of total nuclear cells(TNC) and CD34(+) cells were 3.90(1.97-13.50)×10(7)/kg and 2.07(0.40-5.56)×10(5)/kg. The cumulative incidence of sustained donor engraftment was 94.5% (95% CI 94.5%-94.6%) at a median of 18 days after transplantation (range, 12-37 days). The cumulative incidence of platelet recovery at 180 days after transplantation was 82.1% (95% CI 81.8%-82.4%) with a median time to recovery of 40 (range, 15-153) days. Incidences of grade Ⅱ~Ⅳ and Ⅲ~Ⅳ acute GVHD were 21.8% and 10.9% respectively. The cumulative incidence of chronic GVHD was 17.9%. During a median follow up period of 26 (range 6-94) months, the disease free survival (DFS) and overall survival (OS) rates at 3 years were 54.5% and 58.8%, respectively. The transplantation-related mortality (TRM) at 180 days after transplantation was 22.7%. The cumulative incidence of 3-year relapse rate was 18.3% (95% CI 17.9%-18.6%).
  
  
  CONCLUSIONS
  UCBT with intensified myeloablative conditioning regimen not only improves the donor engraftment, but also shortens the interval of neutrophil and platelet recovery. It is a safe and effective option for children and adult ALL patients lack of matched related donors.
authors.affiliation: Institute of Hematology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China.
authors.forename: Baolin
authors.initials: B
authors.lastname: Tang
authors.forename: Changcheng
authors.initials: C
authors.lastname: Zheng
authors.forename: Huilan
authors.initials: H
authors.lastname: Liu
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Zhu
authors.forename: Liangquan
authors.initials: L
authors.lastname: Geng
authors.forename: Xingbing
authors.initials: X
authors.lastname: Wang
authors.forename: Kaiyang
authors.initials: K
authors.lastname: Ding
authors.forename: Wen
authors.initials: W
authors.lastname: Yao
authors.forename: Juan
authors.initials: J
authors.lastname: Tong
authors.forename: Kaidi
authors.initials: K
authors.lastname: Song
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.forename: Ping
authors.initials: P
authors.lastname: Qiang
authors.forename: Xuhan
authors.initials: X
authors.lastname: Zhang
authors.forename: Zimin
authors.initials: Z
authors.lastname: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D002066:Busulfan / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D003520:Cyclophosphamide / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005312:Fetal Blood / Q000166:cytology; D006086:Graft vs Host Disease / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D003561:Cytarabine; D003520:Cyclophosphamide; D014740:Vidarabine; D002066:Busulfan; D009173:Mycophenolic Acid; C024352:fludarabine