Higher Early Monocyte and Total Lymphocyte Counts Are Associated with Better Overall Survival after Standard Total Body Irradiation, Cyclophosphamide, and Fludarabine Reduced-Intensity Conditioning Double Umbilical Cord Blood Allogeneic Stem Cell Transplantation in Adults.
This single-center retrospective study aimed to report the impact of early hematopoietic and immune recoveries after a standard total body irradiation, cyclophosphamide, and fludarabine (TCF) reduced-intensity conditioning (RIC) regimen for double umbilical cord blood (dUCB) allogeneic stem cell transplantation (allo-SCT) in adults. We analyzed 47 consecutive patients older than 17 years who engrafted after a dUCB TCF allo-SCT performed between January 2006 and April 2013 in our department. Median times for neutrophil and platelet recoveries were 17 (range, 6 to 59) and 37 days (range, 0 to 164), respectively. The 3-year overall (OS) and disease-free survivals, relapse incidence, and nonrelapse mortality were 65.7%, 57.2%, 27.1%, and 19%, respectively. In multivariate analysis, higher day +30 monocyte (≥615/mm(3); hazard ratio [HR], .04; 95% confidence interval [CI], .004 to .36; P < .01) and day +42 lymphocyte (≥395/mm(3); HR, .16; 95% CI, .03 to .78; P = .02) counts were independently associated with better OS. These results suggest that early higher hematopoietic and immune recovery is predictive of survival after dUCB TCF RIC allo-SCT in adults. Factors other than granulocyte colony-stimulating factor, which was used in all cases, favoring expansion of monocytes or lymphocytes, should be tested in the future as part of the UCB transplantation procedure.
Centre Hospitalier et Universitaire de Nantes, Département d'Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France. Electronic address: amandine.lebourgeois@chu-nantes.fr.
Amandine
A
Le Bourgeois
Centre Hospitalier et Universitaire de Nantes, Département d'Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
Pierre
P
Peterlin
Centre Hospitalier et Universitaire de Nantes, Département d'Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
Thierry
T
Guillaume
Centre Hospitalier et Universitaire de Nantes, Département d'Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
Jacques
J
Delaunay
Unité d'ingénierie cellulaire, EFS Pays de la Loire, Nantes, France.
Alix
A
Duquesne
Centre Hospitalier et Universitaire de Nantes, Département d'Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
Steven
S
Le Gouill
Centre Hospitalier et Universitaire de Nantes, Département d'Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France.
Philippe
P
Moreau
Hôpital saint Antoine, Département d'Hématologie Clinique, Paris, France.
Mohamad
M
Mohty
Institut de Cancérologie de l'Ouest - Centre René Gauducheau - Saint-Herblain, France; Université de Nantes and INSERM CRNCA UMR 892, Nantes, France.
Loïc
L
Campion
Centre Hospitalier et Universitaire de Nantes, Département d'Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie (CI2C), Nantes, France; Université de Nantes and INSERM CRNCA UMR 892, Nantes, France.
Patrice
P
Chevallier
D000293:Adolescent; D000328:Adult; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D006085:Graft Survival; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000166:cytology*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000166:cytology*; D019172:Transplantation Conditioning / Q000379:methods* / Q000401:mortality; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014916:Whole-Body Irradiation; D055815:Young Adult
D016179:Granulocyte Colony-Stimulating Factor; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine
Adults; Allogeneic stem cell transplantation; Double umbilical cord blood; Hematological recovery; Immune recovery; Reduced-intensity conditioning regimen