title: [Comparison of intensified myeloablative conditioning regime without antithymocytic globulin (ATG) with myeloablative conditioning regime for single-unit unrelated umbilical cord blood transplantation in hematological malignancies].
abstract: OBJECTIVE
  To campare the effect and tolerance beween intensified myeloablative conditioning regime (IMCR) without antithymocyte globulin (ATG) and myeloablative conditioning regime (MCR) for single-unit unrelated umbilical cord blood transplantation (sUCBT) in hematological malignancies.
  
  
  METHODS
  The clinical data of 190 patients with hematological malignancies undergoing sUCBT between April 2000 and December 2013 at Department of Hematology, Anhui Provincial Hospital were retrospectively analyzed, of whom 156 received IMCR without ATG (IMCR group), including 79 patient receiving total body irradiation (TBI)/cytosine arabinoside (Ara-C)/cyclophosphamide (CY) regime, 47 receiving fludarabine (Flu)/busulfan (Bu)/CY regime, and 30 receiving Ara-C/Bu/CY regime, and all of the 156 received a combination of cyclosporine A (CsA) and mycophelonate mofetil (MMF) for the prophylaxis of graft-versus-host disease (GVHD); the remaining 34 patients received MCR (MCR group), 30 patients receiving Bu/CY regime, and 4 receiving TBI/CY regime, all using CsA/MMF±ATG or methotrexate (MTX) for the prophylaxis of GVHD. The two groups were compared in disease status at the time of transplantation, characteristics of graft, transplantation effect, and transplantation-related complications.
  
  
  RESULTS
  There were no statistically significant differences between the two groups in gender, disease type, human leukocyte antigen match, ABO blood type match, and disease status at the time of transplantation (all P>0.05). The median age and body weight at transplantation in the IMCR group were significantly higher than those in the MCR group (13 years vs 9 years, P=0.003; 44 kg vs 26 kg, P=0.000). The median doses of infused total nucleated cells (×10(7)/kg) and CD34(+) cells (×10(5)/kg) in the IMCR group were significantly lower than in the MCR group (3.87 vs 4.99, P=0.002; 2.00 vs 3.17, P=0.000). The cumulative incidence of myeloid engraftment on the 42th day and platelet engraftment on the 120th day in the IMCR group were remarkably higher than in the MCR group [96.33%(95%CI: 96.27%-96.39%)vs 82.30%(95%CI: 80.67%-83.93%), P=0.000; 86.44%(95%CI: 86.28%-86.60%)vs 51.17%(95%CI: 49.02%-53.32%), P=0.002]. There were no statistically significant differences in the incidences of grade Ⅱ to Ⅳ acute GVHD, grade Ⅲ to Ⅳ acute GVHD, and 2-year chronic GVHD(P=0.482, 0.928, 0.579). The incidence of pre-engraftment syndrome in the IMCR group was higher than in the MCR group(82.70% vs 47.06%, P=0.000). And 180-day transplantation-related mortality (TRM) in the IMCR group was lower than that in the MCR group [20.50%(95%CI: 20.28%-20.71%)vs 42.20% (95%CI: 41.32%-45.09%), P=0.004]. Up to October 2015, with a median follow-up of 44.2(22.7-188.9)months, the estimated 3-year overall survival and disease-free survival in the IMCR group were both significantly higher than those in the MCR group (62.90% vs 34.10%, P=0.000; 58.60% vs 34.10%, P=0.001).
  
  
  CONCLUSIONS
  IMCR without ATG may improve the engraftment without increasing complications, reduce early transplantation-related mortality, and improve survival.
authors.affiliation: Department of Hematology, Affiliated Provincial Hospital, Anhui Medical University, Hefei 230001, China.
authors.forename: Z M
authors.initials: ZM
authors.lastname: Sun
authors.forename: H L
authors.initials: HL
authors.lastname: Liu
authors.forename: Y
authors.initials: Y
authors.lastname: Wu
authors.forename: L Q
authors.initials: LQ
authors.lastname: Geng
authors.forename: C C
authors.initials: CC
authors.lastname: Zheng
authors.forename: B L
authors.initials: BL
authors.lastname: Tang
authors.forename: X Y
authors.initials: XY
authors.lastname: Zhu
authors.forename: J
authors.initials: J
authors.lastname: Tong
authors.forename: X B
authors.initials: XB
authors.lastname: Wang
authors.forename: K Y
authors.initials: KY
authors.lastname: Ding
authors.forename: X
authors.initials: X
authors.lastname: Wan
authors.forename: L
authors.initials: L
authors.lastname: Zhang
authors.forename: W
authors.initials: W
authors.lastname: Yao
authors.forename: X H
authors.initials: XH
authors.lastname: Zhang
authors.forename: Y S
authors.initials: YS
authors.lastname: Han
authors.forename: H Z
authors.initials: HZ
authors.lastname: Yang
authors.forename: X
authors.initials: X
authors.lastname: Liu
authors.forename: W W
authors.initials: WW
authors.lastname: Zhu
authors.forename: J S
authors.initials: JS
authors.lastname: Wu
authors.forename: Z Y
authors.initials: ZY
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000627:therapeutic use; D002066:Busulfan / Q000008:administration & dosage* / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000627:therapeutic use / Q000633:toxicity; D016572:Cyclosporine; D003561:Cytarabine / Q000008:administration & dosage / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D005312:Fetal Blood / Q000166:cytology; D006086:Graft vs Host Disease / Q000517:prevention & control; D006680:HLA Antigens; D019337:Hematologic Neoplasms / Q000601:surgery* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D014740:Vidarabine / Q000031:analogs & derivatives; D014916:Whole-Body Irradiation
chemical_list: D006680:HLA Antigens; D003561:Cytarabine; D016572:Cyclosporine; D003520:Cyclophosphamide; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine