Long-term follow-up and factors influencing outcomes after related HLA-identical cord blood transplantation for patients with malignancies: an analysis on behalf of Eurocord-EBMT

AbstractWe analyzed risk factors influencing outcomes after related (R) human leukocyte antigen-identical cord blood transplantation (CBT) for 147 patients with malignancies reported to Eurocord–European Group for Blood and Marrow Transplantation. CBT has been performed since 1990; median follow-up was 6.7 years. Median patient age was 5 years. Acute leukemia was the most frequent diagnosis (74%). At CBT, 40 patients had early, 70 intermediate, and 37 advanced disease. CB grafts contained a median of 4.1 × 107/kg total nucleated cells (TNCs) after thawing. The cumulative incidence (CI) of neutrophil recovery was 90% at day +60. CIs of acute and chronic graft-versus-host disease (GVHD) were 12% and 10% at 2 years, respectively. At 5 years, CIs of nonrelapse mortality and relapse were 9% and 47%, respectively; the probability of disease-free survival (DFS) and overall survival were 44% and 55%, respectively. Among other factors, higher TNCs infused was associated with rapid neutrophil recovery and improved DFS. The use of methotrexate as GVHD prophylaxis decreased the CI of engraftment. Patients without advanced disease had improved DFS. These results support banking and use of CB units for RCBT. Cell dose, GVHD prophylaxis not including methotrexate, and disease status are important factors for outcomes after RCBT.

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Low-Dose Methotrexate Could Reduce Severe Early Immune Reactions but Probably Increase Garft Failure in Umbilical Cord Blood Transplantation

Blood ◽

10.1182/blood-2019-131524 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5679-5679

Author(s):

Liu Huilan ◽

Xiaoyu Zhu ◽

Kaidi Song ◽

Xiang Wan ◽

Guangyu Sun ◽

...

Keyword(s):

Cord Blood ◽

Graft Versus Host Disease ◽

Low Dose ◽

Cord Blood Transplantation ◽

Immune Reactions ◽

Graft Versus Host ◽

Blood Transplantation ◽

Dose Methotrexate ◽

Gvhd Prophylaxis

Early immune disorders, including preengraftment syndrome (PES)and acute graft-versus-host disease(aGvHD)are problematic in cord blood transplantation (CBT), and optimal prophylaxis has not been established. Here, we prospectively investigated whether intensive GvHD prophylaxis by adding low-dose methotrexate (MTX)at day 3 after CBThas a prognostic impact on CBT. 16 consecutive single-unit CBT recipients treated for high-risk hematologic malignancies (10 cases) and non-malignancies (6 cases) between February 2019 and March 2019. The patients, 6 female and 10 males, had a median age of 9 years (range 4-40) and a median weight of 26 kg (range 14-68). Myeloablative preparative regimen comprised fludarabine, busulfan and cyclophosphamide for malignancies and reduced-intensity-conditioning comprised fludarabine, cyclophosphamide and total-body irradiation (4 Gy) for non-malignancies. Graft-versus-host disease (GvHD) prophylaxis was cyclosporine and mycophenolate mofetil plus MTX 3 mg/m2 on day+3. 14 patients achieved engraftment at a median of day 19 and had more than 95% (complete) donor chimerism on day+14.Two patients without hematopoietic reconstitution were engrafted after a second CBT. PES was characterized by high-grade fever, rash, pulmonary edema, weight gain, liver and renal dysfunction developed on a median of day 8 in 11 of the 16 evaluable patients, including 2 who did not achieve engraftment. The PES patients received intravenous corticosteroid at a median dose of 1 mg/kg/day, and of these, 2 patients were requiredBasiliximab to improve clinical symptoms. Grade I to IV and aGvHD developed in 4 and only 1 patient developed severe aGvHD with Grade Ⅲ. Follow-up so far, one death occurred at day 103 because of pneumonia. 15 patients are alive well at a median follow-up of 135 days (131-163). Adding low-dose MTX at day +3 may be offer one optimal regimen to reduce severe early immune reactions and improve outcomes in CBT. Disclosures No relevant conflicts of interest to declare.

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Sequential Transplantation of Haploidentical Stem Cell and Unrelated Cord Blood With Using ATG/PTCY Increases Survival of Relapsed/Refractory Hematologic Malignancies

Frontiers in Immunology ◽

10.3389/fimmu.2021.733326 ◽

2021 ◽

Vol 12 ◽

Author(s):

Hua Li ◽

Xiaofan Li ◽

Yiling Chen ◽

Duihong Li ◽

Xianling Chen ◽

...

Keyword(s):

Cord Blood ◽

Cord Blood Transplantation ◽

Chronic Gvhd ◽

Disease Free Survival ◽

Hematologic Malignancies ◽

Post Transplantation ◽

Blood Transplantation ◽

Gvhd Prophylaxis ◽

Unrelated Donors ◽

Unrelated Cord Blood

Allogeneic haploidentical HSCT (haplo-HSCT) and unrelated umbilical cord blood transplantation(UCBT)are used in patients lacking HLA-identical sibling or unrelated donors. With myeloablative condition and GVHD prophylaxis of using low-dose ATG and post-transplantation cyclophosphamide (PTCY), we conducted a prospective clinical trial. Of eligible 122 patients from February 2015 to December 2019 in the study, 113 patients were involved. Forty-eight patients were in the group of sequential haplo-cord transplantation (haplo-cord HSCT), and 65 patients were in the group of single UCBT. The primary endpoint of 2-year disease-free survival (DFS) was no statistical difference between groups (64.1 vs. 56.5%), p>0.05. The analysis of subgroup patients with relapsed/refractory showed haplo-cord HSCT was associated with better OS (HR 0.348, 95% CI, 0.175–0.691; p=0.0025), DFS (HR 0.402, 95% CI, 0.208–0.779; p=0.0069), and GRFS (HR 0.235, 95% CI, 0.120–0.457, p<0.0001) compared to the single cord group. The 2-year’s probability in OS, DFS, and GRFS was 64.9 vs. 31.6%, 64.5 vs. 31.6%, and 60.8 vs. 15.0% in the haplo-cord group and single cord group, respectively. III-IV acute GVHD 8.3 vs. 6.2%, chronic GVHD 25.8 vs. 13.7%, and extensive chronic GVHD 5.3 vs. 1.8% were shown in corresponding group, p>0.05. The patients engrafted persistently with UCB showed better survival outcomes. Our sequential Haplo-cord HSCT with ATG/PTCY improved the survival of patients and might be an alternative transplantation approach for patients with relapsed/refractory hematologic malignancies.

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Adult Umbilical Cord Blood Transplantation Following Non-Myeloablative Conditioning; Impact of Increased Cell Dose and 200cGy TBI on Engraftment and Survival.

Blood ◽

10.1182/blood.v108.11.5399.5399 ◽

2006 ◽

Vol 108 (11) ◽

pp. 5399-5399 ◽

Cited By ~ 1

Author(s):

Mitchell Horwitz ◽

David Rizzieri ◽

Gwynn D. Long ◽

Cristina Gasparetto ◽

Ashley Morris ◽

...

Keyword(s):

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Cord Blood Transplantation ◽

Disease Free Survival ◽

Free Survival ◽

Cell Dose ◽

Blood Transplantation ◽

Disease Free

Abstract Reliable engraftment following transplantation of partially matched umbilical cord blood is dependent upon adequate immunosuppression and myelosuppression. The lowest intensity conditioning regimen that will provide reliable cord blood engraftment in adult patients has not been determined. 26 adult patients with a contraindication for myeloablative marrow conditioning due to advanced age or comorbidities, underwent non-myeloablative umbilical cord blood transplantation for hematologic malignancies. The first 13 patients (Cohort 1) were conditioned with Fludarabine 120mg/m2, Cyclophosphamide 2g/m2 and horse Antithymocyte globulin 90mg/kg. Cyclosporine and Mycophenolate Mofetil was administered for GvHD prophylaxis. The median cell nucleated dose was 2.1 × 107/kg and median follow-up is 60 months (Chao 2004 BBMT 10:569). After protocol revision, 200 cGy total body irradiation was added to the regimen described above. In addition, the minimum nucleated cell dose provided from up to two cord blood units was increased to 3 × 107/kg (Cohort 2). With a median follow-up of 12 months, we now report the outcome of cohort 2. Fourteen patients with AML CR1 (2), CR≥2 (5), CML (1), MDS/AML (1), MDS (4), or Follicular Lymphoma (1) and a median age of 54 (range 21–72) were transplanted. Eight patients required dual cord blood grafts to achieve the minimum cell dose. All grafts were at least 4/6 HLA matches (antigen level class I, allele level class II) with the patient, and with each other (dual cord blood grafts). The median cryopreserved and infused nucleated cell dose was 3.6 × 107/kg and 3.5 × 107/kg respectively. Two patients were not evaluable for engraftment due to early toxic death. Two patients experienced primary graft failure. Acute GvHD (grade II skin) was observed in 2 patients. Limited chronic GvHD developed in 2 patients. Parainfluenza type 3 sinusitis and pneumonitis caused significant morbidity in 5 patients. Day 100 treatment-related mortality occurred in 4 patients (30%) due to; infection (2), hemorrhage (2). Relapse occurred in 5 patients (36%). The estimated one year overall and disease-free survival is 25% and 17%, respectively. T-cell recovery was slow. The median CD4 count/ul for engrafted patients was 44 (range 4–516) and 61(range 2–237) at 3 and 6 months following transplantation, respectively. The median CD8 count/ul was 7 (range 0–359) and 108 (range 0–728) at 3 and 6 months following transplantation, respectively. A comparison of results from the two cohorts is presented in the table. The addition of 200cGy and increasing the cell dose facilitated by dual cord blood transplantation doubled the chance for sustained donor engraftment. Improved engraftment was accompanied by increased treatment-related morbidity and mortality, erasing the potential for improved disease-free survival. Disease relapse, in part due to slow immune recovery resulting in impaired anti-tumor response, was the other major impediment to successful outcome. Techniques focused on enhancing immune recovery would significantly improve outcomes of adult cord blood transplantation. Comparison of Cohort 1 vs Cohort 2 Evaluable Patients Med. Nuc Cell Dose/kg D100 TRM(%) Sustained Donor Engraftment (%)† Disease-Free Survival(%)† †estimated (1yr) *P=0.08 **P=NS Flu / Cy / ATG (Cohort 1) 13 2.1 × 107 15 41 15 Flu/Cy/ATG/200cGy(Cohort 2) 12 3.5 × 107 30 83* 17**

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Unrelated Cord Blood Transplantation (UCBT) in Adults with MDS or Secondary Acute Myeloblastic Leukemia (sAML): a Survey On Behalf of Eurocord and CLWP of EBMT.

Blood ◽

10.1182/blood.v114.22.1198.1198 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1198-1198

Author(s):

Marie Robin ◽

Guillermo Sanz ◽

Irina Ionescu ◽

Bernard Rio ◽

Anne Sirvent ◽

...

Keyword(s):

High Risk ◽

Cord Blood ◽

Median Time ◽

Advanced Disease ◽

Cord Blood Transplantation ◽

Conditioning Regimen ◽

Neutrophil Recovery ◽

Unrelated Cord Blood Transplantation ◽

Blood Transplantation ◽

Unrelated Cord Blood

Abstract Abstract 1198 Poster Board I-220 Background: Unrelated cord blood transplantation is an alternative option to treat patients with high risk hematologic malignancies in the absence of an HLA identical donor. Results of UCBT in patients with MDS or secondary leukaemia (sAML) have been scarcely published. Method: We performed a survey to identify predictors of outcomes in a large cohort of 108 adults with MDS or sAML reported to Eurocord-Promise data bases (62 centres in 17 countries in Europe) and transplanted with an UCBT from 1998 to 2007. Sixty-seven patients were transplanted for sAML (secondary to MDS in 42 cases) and 41 for MDS. Worst status before UCBT for MDS was RA in 4, RAEB1 in 10, RAEB2 in 14, CMML or RAEBt in 9, unclassified in 4 patients. IPSS classification at transplantation was low, intermediate 1, intermediate 2, high or missing in 8, 12, 7, 6 and 8 patients, respectively. For patients with sAML, 48% were transplanted in CR1 at UCBT. Median age at UCBT was 43 years (from 18 to 72 years). Median time from diagnosis to UCBT was 10 months. Transplant characteristics: 77 patients received a single and 31 a double UCBT. UCB grafts had ≥ 2/6 HLA mismatched in 60 % of cases. Myeloablative conditioning regimen (MAC) was given to 57 patients whereas 51 patients received a reduced intensity conditioning regimen (RIC). GVHD prophylaxis consisted in CSA+MMF in 52, CSA+steroids in 43 and other combinations in 13 patients. Median number of collected nucleated cells was 3.4 for single and 4.6 × 107/kg for double UCBT. Median follow-up was 25 months. Results: cumulative incidence (CI) of neutrophil recovery at day 60 was 82±4% with a median time to achieve more than 500 ANC/mm3 of 23 days. Neutrophil recovery was independently associated with number of CD34+ cells/kg (> 1.1 × 105, Hazard Ratio (HR), 1.79; P= .02) and advanced disease status (intermediate 2 or high MDS and sAML not in CR; HR, 1.92; P= .007). CI of grade II-IV acute GVHD at day 100 and chronic GVHD at 2 years were 26±4% (II n=18, III n=6, IV n =6) and 42%±8, respectively. Two-year non-relapse mortality was significantly higher after MAC (62% vs. 34%, p=0.009). In counterpart, 2-year relapse rate was higher after RIC (14% vs 29%, p=0.02). Two-year DFS and OS were 30 and 34%, respectively. In univariate analysis, among patient-, disease- and transplant- factors studied only patients with high risk disease at maximal pre-transplant stage or transplanted > 18 months after diagnosis had significant poorer DFS (disease risk: 49% vs. 22%; time: 35% vs. 15%). However, in multivariate analysis, the only factor associated with decreased DFS was advanced disease (HR: 2.05; p= .01). Conclusion: These data indicate that UCBT is an acceptable alternative option to treat adults with high risk MDS or sAML without a HLA-matched related or unrelated bone marrow donor. Controlled disease at time of transplantation improves outcome. More investigations are needed to compare these results with outcomes after other stem cell sources from unrelated HSCT donor. Disclosures: No relevant conflicts of interest to declare.

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Pre-Transplant Conditioning Using Intravenous Busulfan Is a Feasible and Effective Option in Reduced-Intensity Cord Blood Transplantation.

Blood ◽

10.1182/blood.v112.11.3273.3273 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3273-3273

Author(s):

Naoyuki Uchida ◽

Hisashi Yamamoto ◽

Naofumi Matsuno ◽

Kazuya Ishiwata ◽

Masanori Tsuji ◽

...

Keyword(s):

Cord Blood ◽

Performance Status ◽

Cord Blood Transplantation ◽

Disease Free Survival ◽

Ecog Performance Status ◽

Neutrophil Recovery ◽

Post Transplant ◽

Blood Transplantation ◽

Medium Range ◽

Reduced Intensity

Abstract Although cord blood (CB) transplantation with reduced-intensity conditioning (RICBT) has been widely applied to those who lack available related or unrelated donors and are not eligible for conventional conditioning, the optimal pre-transplant conditioning has not been established yet. Intravenous busulfan (ivBu) has been incorporated in conditioning regimens before bone marrow or peripheral blood stem cell transplantation, but the feasibility in cord blood transplantation has been controversial. In order to address this issue, we retrospectively reviewed patients who underwent RICBT including ivBu. Twenty-one patients, who were at ECOG performance status of 2 or less and received RICBT at our institute from June 2007 to April 2008 consecutively, were included in this study. Median age was 56 years (range, 21–71). Seventeen were AML, 3 were ALL, and 1 was MDS RA. All but 2 (MDS RA and ALL in CR2) were not in remission, 5 had CNS involvement, and 9 had history of prior transplantation. Seventeen had HCT-specific comorbidity index score ≥1, including 8 ≥2, and 6 ≥3. Fludarabine phosphate 125–180mg/m2 and ivBu 6.4–12.8mg/kg were used in all patients. All but 2 received additional melphalan (Mel) or total body irradiation (TBI); Mel 80–140mg/m2 for 10, 2–8Gy of TBI for 8, and Mel 40mg/m2 plus 4Gy of TBI for 1. Graft-versus-host disease prophylaxis consisted of tacrolimus plus mycophenolate mofetil in 11, tacrolimus alone in 8, and cyclosporine alone in 1. Single cord blood units, matched at 4/6 in 20 and 5/6 in 1, of 2 x 107/kg of recipient body weight at minimum were infused. Seventeen achieved neutrophil recovery ≥500/μl on day 19 post-transplant at medium (range, 12–30). Among 4 who failed to achieve neutrophil recovery, 2 experienced early disease progression, 1 showed rejection, and 1 died before engraftment due to interstitial pneumonia. All 17 patients who achieved neutrophil engraftment and 1 who died before engraftment showed complete donor-type chimerism on 13 days post-transplant at medium (range, 8–35). Median follow-up time of survivors was 398 days (range, 162–532) post-transplant. Cumulative incidence of non-relapse mortality at day 100 and day 365 post-transplant were both 19%. No VOD/SOS was observed. Disease-free survival and overall survival (OS) at 1 year post-transplant were 40±11% and 61±9%, respectively. Thus, ivBu can be safely administered, and have potential to achieve successful engraftment as well as sufficient disease control, indicating possible benefit of incorporating this drug in pre-transplant conditioning of RICBT. The optimal dosing schedule or combination with other therapeutic modalities needs further investigation in prospective clinical trials.

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Reduced-Intensity Cord Blood Transplantation without Preceding Remission Induction Therapy Induces Durable Remission in Patients with Relapsed Acute Leukemia After the First Allogeneic Stem Cell Transplantation.

Blood ◽

10.1182/blood.v114.22.4341.4341 ◽

2009 ◽

Vol 114 (22) ◽

pp. 4341-4341

Author(s):

Toshimitsu Ueki ◽

Kentaro Nasu ◽

Ikuo Shimizu ◽

Masahiko Sumi ◽

Mayumi Ueno ◽

...

Keyword(s):

Cord Blood ◽

Induction Chemotherapy ◽

Induction Therapy ◽

Cord Blood Transplantation ◽

Remission Induction ◽

Blood Transplantation ◽

Receive Induction Chemotherapy ◽

Gvhd Prophylaxis ◽

Reduced Intensity

Abstract Abstract 4341 Relapses in acute leukemia (AL) following allogeneic stem cell transplantation (allo-SCT), particularly those relapses within 1 year after transplantation, are often refractory to induction chemotherapy. Patients with this type of relapse rarely achieve long-term remission even after the second SCT. Cord blood transplantation, performed in a timely manner, may improve treatment outcomes in these patients. To assess the effectiveness of second cord blood transplantation (CBT) with a reduced intensity conditioning (RIC) regimen early after the diagnosis of leukemia relapse, we retrospectively analyzed outcomes from RIC-CBT without preceding remission induction therapy in 11 consecutive patients. Between 2007 and 2009, we performed CBTs with a RIC regimen for 11 patients with AL who relapsed after allo-SCT. Seven patients were diagnosed with acute myeloid leukemia and four with acute lymphoblastic leukemia. Median duration between the first and the second SCT was six months (range: 3-24 months). Median duration between the relapse and the second SCT was 39 days (range: 22-60 days). All but one patient didnot receive induction chemotherapy due to the low probability of achieving complete remission (CR),and another patient didnot receive induction chemotherapy due to low blast percentage in bone marrow. Mean blast counts in bone marrow and peripheral blood were 39.3% and 22.1%, respectively. All but one patient were conditioned with fludarabine (25 mg/m2/day) from Day -8 to Day -4, with L-PAM (40 mg/m2/day) from Day -3 to Day -2, and with TBI (4Gy) on Day -1. Only FK506 was administered to patients as a graft versus host disease (GVHD) prophylaxis. Mean concentrations of FK506 during the first, second, third, and fourth 10-day period after CBT were 8.9, 8.9, 10.2, and 9.8 ng/ml, respectively. Median follow-up period was 12 months after transplantation in patients who survived. Six patients were alive at the last follow-up with a 1-year and 2-year OS rate of 72.7% and 36.4%, respectively. Five of these 6 patients have been maintaining CR. Four of the 5 patients maintaining CR were considered to be at an extremely high risk for relapse because they relapsed within 8 months (median: 5.5 months, range: 5 to 8 months) after the first SCT. These 4 patients have maintained CR with a median follow-up of 12 months (range: 7 to 32 months). The 2-year probabilities of transplant-related mortality (TRM), relapse-free survival (RFS), and relapse were 27.3%, 40.9%, and 42.9%, respectively. RIC-CBT without preceding remission induction therapy using a relatively low concentration of FK506 as a GVHD prophylaxis may be a promising therapeutic option for patients with AL who relapse shortly after the first transplantation. Age/Sex Disease Donor type of 1st SCT Preparative regimen of 1st SCT Time (months) from 1st SCT to relapse Time (days) from relapse to 2nd SCT Blast BM Blast PB Status last follow up Overall Survival (months) 53/F AML MUD TBI-CY 12 42 31.8% 3% death no relapse 3 42/M AML CB TBI-CY 5 37 49.4% 6% alive CR 32 40/F AML CB BU-CY-TBI 5 32 29.0% 81% death relapse 15 38/M AML MUD TBI-CY 21 28 64.8% 80% death no relapse 2 28/F AML SIB Flu-Mel-TBI 24 60 6.4% 1% alive CR 23 19/M ALL SIB TBI-CY 8 35 50.0% 49% death relapse 15 21/M ALL MUD TBI-CY 8 22 73.8% 1% alive CR 7 50/M AML MUD TBI-CY 5 39 9.0% 2% alive CR 9 45/F ALL SIB TBI-CY 6 41 57.8% 4% alive CR 15 55/F ALL(Ph1) SIB TBI-CY 4 41 51.2% 16% alive relapse 6 21/F AML Related TBI-CY 6 42 9.2% 0% death no relapse 3 Disclosures: No relevant conflicts of interest to declare.

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Outcomes After Double Unit Unrelated Cord Blood Transplantation (UCBT) Compared with Single UCBT In Adults with Acute Leukemia In Remission. An Eurocord and ALWP Collaboration Study

Blood ◽

10.1182/blood.v116.21.910.910 ◽

2010 ◽

Vol 116 (21) ◽

pp. 910-910 ◽

Cited By ~ 3

Author(s):

Vanderson Rocha ◽

Myriam Labopin ◽

Mohamad Mohty ◽

Guillermo F Sanz ◽

Bernard Rio ◽

...

Keyword(s):

Multivariate Analysis ◽

Cord Blood ◽

Acute Gvhd ◽

Cord Blood Transplantation ◽

Chronic Gvhd ◽

Univariate Analysis ◽

Neutrophil Recovery ◽

Blood Transplantation ◽

Unrelated Cord Blood

Abstract Abstract 910 The Minnesota group has described that recipients of double unrelated cord blood transplantation (dUCBT) have a higher incidence of acute GVHD, lower relapse incidence (RI) but no difference in leukemia free survival (LFS) when compared to single unit UCBT (sUCBT) recipients. In order to confirm these results in a larger and more homogenous cohort of patients and to evaluate the effect of double UCBT in relapse and LFS, we have compared the outcomes after dUCBT (n=230) with sUCBT (n=377) in adult patients with acute myeloid or lymphoblastic leukemia in remission. There were some differences between the two groups: dUCBT recipients were heavier (median weight: 68kg vs 65kg, p<0.01), tended to be older (median age: 37 years vs 35 years, p=0.06), had lower frequency of poor cytogenetics (32% vs 36%, p=0.02), transplanted more recently (p<0.001), more frequently given RIC (53% vs 30%, p<0.001), and received less ATG/ALG (29% vs 70%, p<0.001) when compared to sUCBT recipients, respectively. No differences were observed in diagnosis (38% ALL and 62% AML), status of disease at transplant (CR1: 52%, CR2:40% and CR3:8%) and previous autograft (13%). As expected, dUCBT recipients received a graft containing a higher nucleated cell dose (median of 3.7×107/kg vs 2.6×107/kg; p<0.0001). Number of HLA disparities were not statistically different (5/6:32% and 4/6:58%) when compared to sUCB grafts. Two analyses for outcomes were performed: one in patients transplanted in CR1 and other in patients transplanted in CR2 or more. The differences between dUCBT and sUCBT remained the same in both analyses. Results: in patients transplanted in CR1, median follow-up was 17 months for dUCBT recipients (n=114) and 19 months for sUCBT recipients (n=203). Unadjusted univariate analysis showed that cumulative incidence (CI) of neutrophil recovery was 78% after dUCBT and 82% after sUCBT (p=0.11); acute GVHD was 45% and 27% (p<0.001), and chronic GVHD 21% and 27% (p=0.35), respectively. At 3 years, unadjusted CI of NRM and RI were 32% after dUCBT and 36% after sUCBT (p=0.89) and 15% and 25% (p=0.03), respectively. Estimated 3 years LFS was 53% after dUCBT and 39% after sUCBT (p=0.09). In multivariate analysis, adjusted for the differences between the 2 groups, dUCBT recipients have an increased risk of grade II-IV acute GVHD (HR 1.23, p=0.005) and decreased RI (HR:0.74, p=0.01) when compared to sUCBT recipients. In a multivariate analysis adjusted, neutrophil and platelets recovery, NRM and chronic GVHD were not statistically different after dUCBT or sUCBT. However, in a multivariate analysis, LFS was improved after dUCBT compared to sUCBT recipients (HR: 0.67, p=0.04). In patients transplanted in CR2 and CR3, median follow-up was 11 months for dUCBT recipients (n=116) and 22 mo for sUCBT recipients (n=174). Unadjusted univariate analysis showed that CI of neutrophil recovery was 85% after dUCBT and 83% after sUCBT (p=0.57); acute GVHD was 33% and 17% (p=0.003), and chronic GVHD 32% and 29% (p=0.64), respectively. At 3 years, unadjusted CI of NRM and RI were 34% after dUCBT and 36% after sUCBT (p=0.47) and 31% and 33% (p=0.68), respectively. Estimated 3 Y LFS was 35% after dUCBT and 31% after sUCBT (p=0.48). In multivariate analysis, adjusted for the differences between the 2 groups, outcomes after dUCBT recipients, namely neutrophil recovery, acute and chronic GVHD, NRM, RI and LFS were not statistically different between the two groups. In conclusion our study confirms the previous findings of higher incidence of acute GVHD, equivalent NRM and reduced relapse in adult recipients of dUCBT, mainly for those transplanted in CR1, showing a higher GVL effect with improved LFS. Outcomes after dUCBT in patients with CR2 and CR3 were not statistically different of sUCBT. Double UCBT has extended the use of UCBT for patients otherwise not eligible for single UCBT and importantly is associated with better outcomes in adults patients with AL transplanted in early phase of the disease. Disclosures: No relevant conflicts of interest to declare.

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Budd-Chiari Syndrome During Long-term Follow-up after Allogeneic Umbilical Cord Blood Transplantation

Internal Medicine ◽

10.2169/internalmedicine.8226-21 ◽

2022 ◽

Author(s):

Yusuke Akitomi ◽

Yoshinari Asaoka ◽

Ryo Miura ◽

Sae Murata ◽

Takatsugu Yamamoto ◽

...

Keyword(s):

Cord Blood ◽

Umbilical Cord Blood ◽

Cord Blood Transplantation ◽

Umbilical Cord Blood Transplantation ◽

Budd Chiari Syndrome ◽

Blood Transplantation ◽

Long Term Follow Up ◽

Chiari Syndrome

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Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies

Blood ◽

10.1182/blood-2004-03-1001 ◽

2004 ◽

Vol 104 (12) ◽

pp. 3813-3820 ◽

Cited By ~ 249

Author(s):

Satoshi Takahashi ◽

Tohru Iseki ◽

Jun Ooi ◽

Akira Tomonari ◽

Kashiya Takasugi ◽

...

Keyword(s):

Bone Marrow ◽

Bone Marrow Transplantation ◽

Cord Blood ◽

Marrow Transplantation ◽

Cord Blood Transplantation ◽

Disease Free Survival ◽

Hematologic Malignancies ◽

Adult Patients ◽

Transplant Recipients ◽

Blood Transplantation

Unrelated cord blood transplantation (CBT) has now become more common, but as yet there have been only a few reports on its outcome compared with bone marrow transplantation (BMT), especially for adults. We studied the clinical outcomes of 113 adult patients with hematologic malignancies who received unrelated BM transplants (n = 45) or unrelated CB transplants (n = 68). We analyzed the hematopoietic recovery, rates of graft-versus-host disease (GVHD), risks of transplantation-related mortality (TRM) and relapse, and disease-free survival (DFS) using Cox proportional hazards models. The time from donor search to transplantation was significantly shorter among CB transplant recipients (median, 2 months) than BM transplant recipients (median, 11 months; P < .01). Multivariate analysis demonstrated slow neutrophil (P < .01) and platelet (P < .01) recoveries in CBT patients compared with BMT patients. Despite rapid tapering of immunosuppressants after transplantation and infrequent use of steroids to treat severe acute GVHD, there were no GVHD-related deaths among CB transplant recipients compared with 10 deaths of 24 among BM transplant recipients. Unrelated CBT showed better TRM and DFS results compared with BMT (P = .02 and P < .01, respectively), despite the higher human leukocyte antigen mismatching rate and lower number of infused cells. These data strongly suggest that CBT could be safely and effectively used for adult patients with hematologic malignancies.

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