Single Cord Blood Transplantation Versus HLA-Haploidentical-related Donor Transplantation Using Posttransplant Cyclophosphamide in Patients With Hematological Malignancies

Abstract Cord blood (CB) is being increasingly used as a source of hematopoietic stem cells for patients in need of stem cell transplantation when a HLA matched-related or unrelated donor is not found. However, cord blood transplantation (CBT) in adults is limited by its lower cell dose. We have started investigating whether transplant with two units of CB will make an engraftment faster and improve outcomes in adult patient lacking a suitable single CB unit. Four transplant centers have participated in this clinical study. Eligibility for this study are as follows; 1) high-risk or advanced hematological malignancy without a related donor, 2) no HLA-matched unrelated BM donor in JMDP or requirement for urgent transplantation, and 3) absence of single HLA 0–2 antigen-mismatched cord blood unit with a cell dose of >2.5x10e7/kg. Eleven patients with hematological malignancies (AML 7, MLL 2, ALL 1, LBL 1) were transplanted with two CB units, following myeloablative conditioning with fractionated TBI(12Gy)+ G-CSF (5?g/kg/dx2days) combined ara-C (12g/?) +CY (120mg/kg) or TBI(12Gy) + CY (120mg/kg). GVHD prophylaxis consisted of short term MTX and CSA. The median age was 33 years (range; 19–52) and median weight was 68kg (range 48– 84). CB grafts were HLA 0–2 antigen-mismatched to the patients and each other, with a median total cryopreserved cell dose of 3.88x10e7/kg (range; 2.83–4.79) and median CD34+ cell dose of 1.06x10e5/kg (0.62–2.6). Nine out of 11 patients engrafted successfully, and had 96–100% single donor chimerism at day+28 bone marrow aspirate. The median time to neutrophil engraftment (ANC >500 /?) was 21days (16–26) and median time to platelets >50000 /?was 53 days (32–98). Nine patients who survived more than 28 days had AGVHD (grade I in 2, II in 3, III in 1), and CGVHD (limited type) was developed in 4 of the 6 evaluable patients. Two patients died of sepsis at day 7 and 27 and one had relapse at day 249. Nine patients are now alive 3 to 16 months after CBT. These preliminary results suggest that multiple unit CBT seems to be useful for adult with hematological malignancies lacking an appropriate BM donor or a single CB unit. Further studies with double-unit CBT may be warranted.

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ALLOGENEIC CORD BLOOD TRANSPLANTATION IN CHILDREN WITH HEMATOLOGICAL MALIGNANCIES: A Long-Term Follow-Up Single-Center Study

Pediatric Hematology and Oncology ◽

10.1080/08880010902773040 ◽

2009 ◽

Vol 26 (4) ◽

pp. 165-174 ◽

Cited By ~ 10

Author(s):

Miguel A. Diaz ◽

Marta Gonzalez-Vicent ◽

Manuel Ramirez ◽

Julian Sevilla ◽

Alvaro Lassaletta ◽

...

Keyword(s):

Cord Blood ◽

Hematological Malignancies ◽

Cord Blood Transplantation ◽

Single Center ◽

Blood Transplantation ◽

Single Center Study ◽

Long Term Follow Up ◽

Center Study

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Adult cord blood transplant results in comparable overall survival and improved GRFS vs matched related transplant

Blood Advances ◽

10.1182/bloodadvances.2020001554 ◽

2020 ◽

Vol 4 (10) ◽

pp. 2227-2235

Author(s):

Prashant Sharma ◽

Enkhtsetseg Purev ◽

Bradley Haverkos ◽

Daniel A. Pollyea ◽

Evan Cherry ◽

...

Keyword(s):

Overall Survival ◽

Cord Blood ◽

Cumulative Incidence ◽

Cord Blood Transplantation ◽

Chronic Gvhd ◽

Blood Transplantation ◽

Cord Blood Transplant ◽

Conditioning Regimens ◽

Related Donor

Abstract We compared outcomes among adult matched related donor (MRD) patients undergoing peripheral blood stem cell transplantation and adult patients undergoing double unit cord blood transplantation (CBT) at our center between 2010 and 2017. A total of 190 CBT patients were compared with 123 MRD patients. Median follow-up was 896 days (range, 169-3350) among surviving CBT patients and 1262 days (range, 249-3327) among surviving MRD patients. Comparing all CBT with all MRD patients, overall survival (OS) was comparable (P = .61) and graft-versus-host disease (GVHD) relapse-free survival (GRFS) was significantly improved among CBT patients (P = .0056), primarily because of decreased moderate to severe chronic GVHD following CBT (P < .0001; hazard ratio [HR], 3.99; 95% confidence interval [CI], 2.26-7.04). Among patients undergoing our most commonly used MRD and umbilical cord blood (CB) myeloablative regimens, OS was comparable (P = .136) and GRFS was significantly improved among CBT patients (P = .006). Cumulative incidence of relapse trended toward decreased in the CBT group (P = .075; HR, 1.85; CI 0.94-3.67), whereas transplant-related mortality (TRM) was comparable (P = .55; HR, 0.75; CI, 0.29-1.95). Among patients undergoing our most commonly used nonmyeloablative regimens, OS and GRFS were comparable (P = .158 and P = .697). Cumulative incidence of both relapse and TRM were comparable (P = .32; HR, 1.35; CI, 0.75-2.5 for relapse and P = .14; HR, 0.482; CI, 0.18-1.23 for TRM). Our outcomes support the efficacy of CBT and suggest that among patients able to tolerate more intensive conditioning regimens at high risk for relapse, CB may be the preferred donor source.

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