title: Lack of impact of umbilical cord blood unit processing techniques on clinical outcomes in adult double cord blood transplant recipients.
abstract: Despite widespread use of umbilical cord blood (UCB) transplantation and distinct practice preferences displayed by individual UCB banks and transplant centers, little information exists on how processing variations affect patient outcomes.
  
  
  
  We reviewed 133 adult double UCB transplants performed at a single center: 98 after reduced-intensity and 35 after myeloablative conditioning. Processing associated with contributing UCB banks and units was surveyed to identify differences in practice. We analyzed effect of selected variables on clinical outcomes of engraftment, dominance, transplant-related mortality, and survival.
  
  
  
  Eighty-eight percent of banks queried currently practice red blood cell (RBC) depletion before cryopreservation. This reflects a shift in practice because previously 65% of banks employed RBC-replete processing methods (i.e., cryopreservation or plasma/volume reduction). Neither neutrophil nor platelet engraftment was affected by processing conditions analyzed. RBC depletion was not associated with clinical outcomes, except in 17 recipients of 2 RBC-replete units, where survival was better than that observed in 116 recipients of ≥1 RBC-depleted units (hazard ratio 3.26, P = 0.004). When analyzed by attributes of the dominant unit, RBC depletion, time in storage, bank years in existence, and inventory size did not affect clinical outcomes. Postthaw viability and CD34 dose were factors impacting engraftment. Notably, all RBC-replete units in this cohort were washed in dextran-human serum albumin before infusion.
  
  
  
  These findings support continued utilization of the entire existing pool of cord blood units, despite recent trends in processing, and have important implications for banking resources and UCB selection practices.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: sarah_nikiforow@dfci.harvard.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Nikiforow
authors.affiliation: Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Shuli
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Snow
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Liney
authors.affiliation: Department of Medical Oncology, Tufts Medical Center, Boston, MA, USA.
authors.forename: Grace Shih-Hui
authors.initials: GS
authors.lastname: Kao
authors.affiliation: Harvard Medical School, Boston, MA, USA; Department of Pathology, Beth Israel Deaconess Hospital, Boston, MA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Haspel
authors.affiliation: Department of Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Shpall
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Glotzbecker
authors.affiliation: Department of Medical Oncology, University of Illinois, Chicago, IL, USA.
authors.forename: R Alejandro
authors.initials: RA
authors.lastname: Sica
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Philippe
authors.initials: P
authors.lastname: Armand
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Koreth
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Vincent T
authors.initials: VT
authors.lastname: Ho
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Alyea
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Jerome
authors.initials: J
authors.lastname: Ritz
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Soiffer
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.affiliation: Harvard Medical School, Boston, MA, USA; Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Bimal
authors.initials: B
authors.lastname: Dey
authors.affiliation: Harvard Medical School, Boston, MA, USA; Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: McAfee
authors.affiliation: Harvard Medical School, Boston, MA, USA; Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Yi-Bin
authors.initials: YB
authors.lastname: Chen
authors.affiliation: Harvard Medical School, Boston, MA, USA; Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Spitzer
authors.affiliation: Harvard Medical School, Boston, MA, USA; Medical Oncology, Beth Israel Deaconess Hospital, Boston, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Avigan
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Corey S
authors.initials: CS
authors.lastname: Cutler
authors.affiliation: Harvard Medical School, Boston, MA, USA; Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Ballen
mesh_terms: D000328:Adult; D000368:Aged; D001800:Blood Specimen Collection / Q000379:methods / Q000592:standards*; D002469:Cell Separation / Q000379:methods; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods / Q000592:standards; D015925:Cryopreservation / Q000379:methods; D004912:Erythrocytes / Q000166:cytology; D005260:Female; D005312:Fetal Blood / Q000166:cytology* / Q000637:transplantation; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000166:cytology; D012189:Retrospective Studies; D066027:Transplant Recipients; D016896:Treatment Outcome; D055815:Young Adult
keywords: processing; transplantation; umbilical cord blood