scholarly journals How I treat: the selection and acquisition of unrelated cord blood grafts

Blood ◽  
2011 ◽  
Vol 117 (8) ◽  
pp. 2332-2339 ◽  
Author(s):  
Juliet N. Barker ◽  
Courtney Byam ◽  
Andromachi Scaradavou
Keyword(s):  
Cord Blood ◽  
Product Information ◽  
Selection Process ◽  
Human Leukocyte ◽  
Unrelated Donor ◽  
Unit Selection ◽  
Stem Cell Source ◽  
Search And Selection ◽  
Unrelated Cord Blood ◽  
Global Inventory

Abstract Use of unrelated donor cord blood (CB) as an alternative stem cell source is increasing, and yet there is little information to guide transplant centers in the unique aspects of the search and selection of CB grafts. There is no mechanism to easily access the global inventory of CB units, nor is the product information provided by all banks standardized. To address these challenges, this manuscript reviews the logistics of the search, selection process, and acquisition of CB grafts as practiced by our center. Topics include who should be considered for a CB search, how to access the global CB inventory, and how to balance total nucleated cell dose and human leukocyte antigen match in unit selection. We discuss aspects of unit quality and other graft characteristics (processing methods, unit age, availability of attached segments, infectious disease, and hemoglobinopathy screening) to be considered. We incorporate these considerations into a unit selection algorithm, including how to select double-unit grafts. We also describe how we plan for unit shipment and the role of backup grafts. This review aims to provide a framework for CB unit selection and help transplantation centers perform efficient CB searches.

The impact of anti-HLA antibodies on unrelated cord blood transplantations

Blood ◽  
2010 ◽  
Vol 116 (15) ◽  
pp. 2839-2846 ◽  
Author(s):  
Minoko Takanashi ◽  
Yoshiko Atsuta ◽  
Koki Fujiwara ◽  
Hideki Kodo ◽  
Shunro Kai ◽  
...  
Keyword(s):  
Cord Blood ◽  
Solid Phase ◽  
Human Leukocyte ◽  
Antibody Detection ◽  
Red Cross ◽  
Hla Antibodies ◽  
Platelet Recovery ◽  
Neutrophil Recovery ◽  
Unrelated Cord Blood ◽  
The Impact

Abstract The majority of cord blood transplantations (CBTs) have human leukocyte antigen (HLA) disparities. We investigated the impact that patients' pretransplantation anti-HLA antibodies have on the outcome of CBTs. Testing for anti-HLA antibody and its specificity was performed retrospectively at the Japanese Red Cross Tokyo Blood Center with sensitive solid-phase antibody detection assays. Among 386 CBTs, which were first myeloablative stem cell transplantations for malignancies and used a single unit of cord blood, 89 tested positive. Among the antibody-positive group, the cord blood did not have the corresponding HLA type for the antibody in 69 cases (ab-positive), while 20 cases had specificity against the cord blood HLA (positive-vs-CB). Cumulative incidence of neutrophil recovery 60 days after transplantation was 83% (95% confidence interval [CI], 79%-87%) for the antibody-negative group (ab-negative), 73% (95% CI, 61%-82%) for ab-positive, but only 32% (95% CI, 13%-53%) for the positive-vs-CB (P < .0001, Gray test). With multivariate analysis, the ab-positive showed significantly lower neutrophil recovery than the ab-negative (relative risk [RR] = 0.69, 95% CI, 0.49-0.96, p = .027). The positive-vs-CB had significantly lower neutrophil recovery (RR = 0.23, 95% CI, 0.09-0.56, P = .001) and platelet recovery (RR = 0.31, 95% CI, 0.12-0.81, P = .017) than the ab-negative. Patients' pretransplantation anti-HLA antibodies should be tested and considered in the selection of cord blood.

Fewer Relapses Following Unrelated Donor Cord Blood (UDCB) Compared to Related or Unrelated Bone Marrow (BM) or Peripheral Blood Cell (PBSC) Transplant in the Treatment of Childhood Relapsed and Very High Risk Acute Lymphoblastic Leukemia (ALL).

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3153-3153
Author(s):  
Donna A. Wall ◽  
Ka Wah Chan ◽  
Bess Bowen ◽  
Lorraine Alexander ◽  
Michael Grimley
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Cord Blood ◽  
Hematopoietic Progenitor Cell ◽  
Unrelated Donor ◽  
Stem Cell Source ◽  
High Risk Disease ◽  
Cell Source ◽  
Preparative Regimen ◽  
First Remission

Abstract With aggressive primary therapy for ALL children who relapse are presenting to transplant after having received more intensive frontline and salvage therapy - resulting in transplant candidates with more resistant disease and at a higher risk for transplant related morbidity/mortality (TRM). Thus the the current generation of children presenting for allogeneic transplant are much more difficult to treat. With the addition of unrelated donor cord blood as an alternative hematopoietic progenitor cell source there is now an unrelated donor product available for a majority of children in a timely fashion. For the last 5 years we have treated all children with ALL coming to transplant with a standard preparative regimen which has minimally changed over that time period. Over the past year all children have received identical immunosuppression regardless of stem cell source. This allows us to analyze the impact of allogeneic stem cell source on the outcome of transplant - the graft-vs.-leukemia effect of the various HSCT sources. Between 3/2001 and 7/2006 a total of 54 transplants (txp) were performed at Texas Transplant Institute for treatment of childhood ALL (median age 8 yr, range 0–17 yrs). There were 13 txp for standard risk disease (CR1: Ph+, requiring more than 28 d to achieve CR1, severe hypodiploidy; CR2 with first remission >36 mo) − 7 CB and 6 BM/PBSC. There were 41 txp for high risk disease (CR2 with first remission <36 mo, >CR2 or not in remission at time of txp) − 31 CB and 10 BM/PBSC. All received TBI (1200 cGy in 6 fractions), cyclophosphamide 120 mg/kg, and either thio-tepa 10mg/kg or VP16 1500 mg/m2, or an additional 150 cGy TBI. There was no adjustment in the preparative regimen for the donor source. The first 26 CB transplants (UDCBT) received ATG 30 mg/kg x 3 days prior to txp, the subsequent patients did not receive ATG. There were 38 UDCBT, 14 matched sibling donor and one each of unrelated donor and partial matched family member (6 PBSC, 8 BM). GVHD prophylaxis was a calcineurin inhibitor combined with steroid or mini-methotrexate and/or sirolimus. The time to ANC>500 and platelet recovery was prolonged in the UDCBT group compared to BM/PBSC (19 vs. 14.5 d for ANC, 57 vs. 23 d for platelet >20,000). There were two graft failures in the UDCBT group - both CR1 patients and both salvaged with a second UDCBT. With median f/u of 270 and 350 days for CB and BM/PBSC respectively there was a significant difference in the risk for relapse (5/37 vs. 9/16; p<0.03), TRM (8/37 – 1 GVHD, 3 MOSF, 2 bacterial, 1 leukoencephalopathy, 1 pulmonary vs. 2/16 -fungus, LPD; p= 0.7). KM survival analysis is shown below: Relapses/N 1 yr DFS 2 yr DFS Standard UDCBT 0/7 86% 86% Standard BM/PBSC 3/6 60% 30% HR UDCBT 5/31 62% 56% HR BM/PBSC 6/10 60% 50% Importantly there have continued to be late deaths in the BM/PBSC group due to relapse with the CB curves remaining stable after 18 months post txp. Despite 80% of the CBT being performed for children with high risk disease there were fewer relapses in the UDCBT cohort suggesting a robust allogeneic effect against ALL in the setting of UDCBT.

A Prospective Study on the Feasibility of Related and Unrelated Donor Search and Hematopoietic Cell Transplantation for Adults with Acute Leukemia at 31 European Transplant Centers

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2385-2385
Author(s):  
Vanderson Rocha ◽  
Mutlu Arat ◽  
Vladimir Koza ◽  
Norbet C Gorin ◽  
Augustin Ferrant ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Cord Blood ◽  
Hla Typing ◽  
First Year ◽  
Unrelated Donor ◽  
Alternative Donor ◽  
Family Donor ◽  
Unrelated Cord Blood ◽  
One Year

Abstract Currently, a donor can be virtually found for all patients with an indication for allo-transplantation due to the increased number of hematopoietic stem cell (HSC) donors and increasing use of umbilical cord blood and haplo-transplants. In this study, we have addressed the question of the feasibility of searching HSC donors grafts [HLA-matched sibling donor (MSD), and alternative donors] and performing such transplants or other treatments (such as autologous HSC transplant or chemotherapy) for adults with acute leukemia for whom an indication of allo-HSCT could be planned during the course of their disease. The second objective was to compare in an “intent to treat” analysis, LFS according to planned strategy treatment. Patients were included at HLA typing test. A specific questionnaire was completed specifying the initial strategies planned for each patient and their changes over the period: at HLA typing, after 3, 6, 9, 12 months after the registration, and twice a year for the following 2 years. From 2003 to 2006, 702 adults were enrolled by 31 EBMT centres, 490 had AML, 212 ALL. HLA typing was performed for 443 patients at diagnosis, 172 after first CR, 11 after CR2, and 64 in more advanced phase. Median follow-up was 31 months, median age was 42-years (18–75); 207 patients were aged more than 50 years. A MSD was found for 309 patients (44%). Of 309 patients, 290 patients had 1 MSD, 17 patients 2 MSD and only 2 patients more than 2 donors. In 40 cases where the MDS was found the transplant centres did not planned to perform the transplant. A transplant using a haploidentical donor was planned in 4 cases. At the end, 273 patients were planned to be transplanted from a family donor (269 from a MSD and 4 from an haplo). For the remaining 429 patients, the indication of an auto-HCT was made in 85 (20%) patients, use of chemotherapy as post-remission therapy in 142 (33%) and indication of an allo-HSCT with an alternative donor in 202 (47%). Of those 202 patients, the transplant centres were keen to search for a cord blood donor in 72 cases and for a haplo donor in 11 cases. Analysing the treatment received at the last follow-up and comparing with the strategy planned at the registration, 215 of 270 (80%) patients were transplanted with a family donor, 112 of 142 (79%) patients were still receiving chemotherapy, 53 of 85 (62%) received an autograft and 118 of 202 (58%) received an unrelated transplant. At last follow-up, 448 patients of 702 patients included received an HSCT (64%). Probability of survival at 2 years for 702 patients was 55%. Interval from HLA typing and HSCT was 125 days for MSD, 148 days for unrelated donor, 167 days for unrelated cord blood and 149 days for autologous transplantation. Cumulative incidence function at one year (CIF; using death as a competing event) for receiving an allograft was 81% if the strategy planned was an allograft with a MSD, 57% for those patients for whom an alternative donor was searched and 6% for those patients for whom an allo-transplant was not planed at inclusion. However, CIF at 1-year for really receiving an allograft was 74% in case of MSD, and only 30% for those patients not having an HLA identical siblingAt 2-years, LFS by initial planned strategy at HLA typing was 43% for those patients in whom a donor search was planned, 47% for those with a planned autologous HSCT, 46% for those with planned chemotherapy and 49% for those with a family transplant. In conclusion, the majority of patients (80%) with AL in European centres are HLA typed at diagnosis or CR1. The majority of patients received a MSD as planned treatment in the first year after HLA typing, in the absence of MSD an alternative donor was searched only for 51% of patients and CIF at one year for performing an allotransplant was 30% however in case of searching for alternative donor, transplantation could be performed in 57% of the cases in the first year. Surprisingly, searching for other alternative donors such as unrelated cord blood or haplo-identical donors, was only done for a small proportion of patients, in spite of encouraging results with both strategies. Therefore, in retrospective studies comparing outcomes of HLA identical sibling, and other alternative donor transplants there is a potential bias linked to the decision to search or not in half of the cases, that is probably linked to patients-, disease- and centre-related factors.

Unrelated Cord Blood Transplantation in India: Breaking the Cost Barrier

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4768-4768
Author(s):  
Satya Prakash Yadav ◽  
Anupam Sachdeva
Keyword(s):  
Cord Blood ◽  
Thalassemia Major ◽  
Unrelated Donor ◽  
Class Iii ◽  
Hematopoietic Stem ◽  
Total Cost ◽  
Duration Of Stay ◽  
Unrelated Cord Blood ◽  
The Cost ◽  
Mean Cost

Abstract Abstract 4768 Background – India, with more than a billion population, has a huge burden of blood and cancer disorders many of which can be cured only by hematopoietic stem cell transplantation (HSCT). More than 1500 transplants have been done till 2005 over a 20 year period in about 10 centers out of which 880 have been allogeneic HSCT and all have been from matched related donors (MRD).Unrelated HSCT is the only option for the patients without a MRD. It is almost impossible to find an unrelated matched donor in India due to ethnic diversity and lack of unrelated donor registries. Some public cord blood banks have been set up in India. So finding a suitable cord blood unit within India is possible. Unrelated Cord Blood Transplant (UCBT) is the only feasible option for patients who need to undergo unrelated HSCT in India but lack of experience and huge costs are perceived barriers. Data from USA showed mean cost of graft for pediatric UCBT was $58,910 and mean cost per day survived in first 100 days (excluding graft cost) was $4522 ((Majhail NS et al. Pediatr Blood Cancer 2010;54:138–143). The costs of UCBT among children in India have not been described previously. Method - We calculated the costs of UCBT within the first 100-days among four children who received UCBT at Sir Ganga Ram hospital from April 2008 to Dec 2010. We also analyzed costs of transplantation in relation to patient age, weight, single vs. double cord, conditioning, Graft vs. Host Disease (GVHD) and mean duration of stay before day 100. Results - The 100-day probability of overall survival was 100%. The mean cost per day survived (excluding costs of graft acquisition) was $402 (range $360-460)) for UCBT recipients. Average total cost of each UCBT was $43500 (Range $32000-52000). Average duration of stay in hospital in first 100 days was 89 days (range 75–100). All grafts were procured from a public cord bank in India. Average cost of graft per cord unit was $5000. Diagnosis was thalassemia major-2, Familial Hemophagocytic Lympho Histiocytosis (HLH)-1 and AML-1. Lowest cost was for AML ($32000) and highest was for Pesaro class III thalassemia major ($52000). Mean age was 2.75 years (range 1–5 year). Mean weight was 12.25 kg (range 10–16 kg). Mean cell dose infused was 7 × 107 nucleated cells/kg weight of recipient (range 3–10 × 107nucleated cells/kg). Conditioning was Busulfan and Cyclophosphamide (BuCY) and Rabbit Anti-Thymoglobulin (ATG) for two patients (1 Thalassemia, 1 AML) costing $1500 per patient, Fludarabine & Melphalan and Campath for HLH costing $2500 and Treosulfan, Thiotepa, Fludarabine and ATG for class III thalassemia costing $7500. Mean cost per day for single cord was $385 and for double cord UCBT was $420. One patient rejected the graft. Three engrafted at median of 32 days (range 28 –39 days). GVHD was seen in two patients (both with double cord). CMV reactivation was seen in all cases. Invasive aspergillosis was seen in one patient who had thalassemia and it lead to highest expenditure. Campath based conditioning was associated with maximum hospital stay in child with HLH. All had Lansky score >90 pre-transplant No one needed dialysis, mechanical ventilation or hepatic veno-occlusive disease. Conclusions - Total cost of UCBT in India is less than the cost of the UCBT graft in USA and mean cost per day in India is almost one tenth of cost per day in USA. Low cost of UCBT in India would make this treatment feasible for many more patients who need to undergo unrelated HSCT. Disclosures: No relevant conflicts of interest to declare.

Unrelated Cord Blood Following Haploidentical HSCT with Post-Transplant Cyclophosphamide Improves Results of Alternative Donor Transplant in Thalassemia Major

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5531-5531
Author(s):  
Chunfu Li ◽  
Yuelin He ◽  
Jianyun Liao ◽  
Wenfeng Xu ◽  
Fuyu Pei ◽  
...  
Keyword(s):  
Cord Blood ◽  
Thalassemia Major ◽  
Current Status ◽  
Unrelated Donor ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
Alternative Donor ◽  
Unrelated Cord Blood ◽  
F 14 ◽  
Donor Transplant

Abstract Background: Hematopoietic stem cell transplantation (HSCT) is cure for thalassemia major (TM). However, a suitable donor (HLA matched sibling and unrelated donor) for HSCT is less than 50%. Alternative donors were recently used in TM HSCT. Some study have found that thalassemia-free survival (TFS) was approximately 70% in haploidentical HSCT (h-HSCT) or unrelated cord blood (UCB) transplant for TM patients. So, it is necessary to find out a better h-HSCT for TM patients. In our early practice in leukemic HSCT we found that outcomes were improved by adding UCB to post-transplant cyclophosphamide (PT/Cy) h-HSCT. The latter associated with high mortality related transplant (32%). Henceforth, we used this termed haplocord transplant in TM. Aim: To develop a high TFS h-HSCT protocol for TM patients. Patients and methods First 10 patients with median age 8 (5-17) old years received NF-13-PT/Cy-TM protocol (fig. 1), in which, UCB was added on day 6 after PT/CY h-HSCT. Following 9 patients with age 9 (4-15) old years received NF-14-PT/Cy-TM protocol (fig. 2), in which three doses Thymoglobuline were added to NF-13-PT/Cy-TM protocol. Cyclophosphamide on day 3 and day 4 after transplant were both GVHD prophylaxis for h-HSCT and conditioning for UCB transplant. The HLA (at HLA-A, -B, -C and ¨CDRB1) for the pair of recipient and donor was 2-loci and more mismatched in h-HSCT and 2-loci and less mismatched in UCB. Results The results of haplocord transplants for all patients were showed in table 1. For first 10 patients, final cord blood engrafted in 4 patients; final haploidentical donor engrafted in 3 patients, 2 patients had a primary rejection. One had a secondary rejection and gave up therapy and died of infection. One patient died of grade IV acute GVHD. TFS is 6/10. For second group patients, final cord blood engrafted in 4 patients; final haploidentical donor engrafted in 3 patients, mixed donor engrafted in 2. No patient rejected his graft; All 9 patients live with transfusion independence. Summary Our data showed that UCB followed PT/Cy h-HSCT using NF-14-PT/Cy-TM protocol improved the results of alternative donor transplant in thalassemia major. Registered in Clinical Trials: NCT02126046, Table 1. Case Gender/Age(Y) TransplantTime Months After Transplantation Last engraftment(Month) Current Status 1 2 3 4 5 6 1 M/8 2012.09 Mix Mix Mix Mix Mix Mix CB (15) Alive 2 M/5 2012.11 CB CB CB CB CB CB CB Alive 3 M/6 2013.01 / / / / / / / Reject 4 M/17 2013.03 PB PB PB PB PB PB PB Alive 5 M/11 2013.11 Mix Mix Mix Mix Mix Mix Mix (14) Dead 6 M/6 2013.12 Mix Mix Mix CB CB CB CB Alive 7 F/17 2014.03 Mix Mix Mix CB CB CB CB Alive 8 F/7 2014.05 PB PB PB PB PB PB PB Alive 9 F/14 2014.05 PB PB PB Dead / / PB (3) Dead 10 M/8 2014.05 / / / / / / / Reject 11 M/9 2014.08 Mix PB PB PB PB PB PB Alive 12 M/9 2014.08 Mix PB PB Mix Mix Mix PB (7) Alive 13 M/9 2014.10 Mix Mix Mix Mix Mix Mix Mix (9) Alive 14 M/4 2014.10 Mix Mix CB CB CB CB CB Alive 15 F/7 2014.11 PB PB PB PB PB PB PB Alive 16 M/8 2014.12 Mix Mix Mix Mix Mix CB CB Alive 17 M/15 2014.12 Mix Mix Mix CB CB CB CB Alive 18 M/14 2015.03 PB PB PB PB PB Alive 19 F/14 2015.06 Mix CB CB Alive PB: Haploidetical PBSC; CB: cord blood Figure 1. Figure 1. Figure 2. Figure 2. Disclosures No relevant conflicts of interest to declare.

scholarly journals HLA mismatch direction in cord blood transplantation: impact on outcome and implications for cord blood unit selection

Blood ◽  
2011 ◽  
Vol 118 (14) ◽  
pp. 3969-3978 ◽  
Author(s):  
Cladd E. Stevens ◽  
Carmelita Carrier ◽  
Carol Carpenter ◽  
Dorothy Sung ◽  
Andromachi Scaradavou
Keyword(s):  
New York ◽  
Human Leukocyte Antigen ◽  
Cord Blood ◽  
Cord Blood Transplantation ◽  
Human Leukocyte ◽  
Hematologic Malignancies ◽  
Leukocyte Antigen ◽  
Blood Transplantation ◽  
Cord Blood Unit ◽  
Unrelated Cord Blood

AbstractDonor-recipient human leukocyte antigen mismatch level affects the outcome of unrelated cord blood (CB) transplantation. To identify possible “permissive” mismatches, we examined the relationship between direction of human leukocyte antigen mismatch (“vector”) and transplantation outcomes in 1202 recipients of single CB units from the New York Blood Center National Cord Blood Program treated in United States Centers from 1993-2006. Altogether, 98 donor/patient pairs had only unidirectional mismatches: 58 in the graft-versus-host (GVH) direction only (GVH-O) and 40 in the host-versus-graft or rejection direction only (R-O). Engraftment was faster in patients with GVH-O mismatches compared with those with 1 bidirectional mismatch (hazard ratio [HR] = 1.6, P = .003). In addition, patients with hematologic malignancies given GVH-O grafts had lower transplantation-related mortality (HR = 0.5, P = .062), overall mortality (HR = 0.5, P = .019), and treatment failure (HR = 0.5, P = .016), resulting in outcomes similar to those of matched CB grafts. In contrast, R-O mismatches had slower engraftment, higher graft failure, and higher relapse rates (HR = 2.4, P = .010). Based on our findings, CB search algorithms should be modified to identify unidirectional mismatches. We recommend that transplant centers give priority to GVH-O-mismatched units over other mismatches and avoid selecting R-O mismatches, if possible.

Comparison of PBSC Vs Cord Blood (CB) As Stem Cells Source for Reduced-Intensity Conditioning Regimen (RIC) Allogeneic Stem Cell Transplantation (allo-SCT) in Adult Patients with Haematological Diseases: A Single Centre Analysis.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3108-3108
Author(s):  
Amandine Lebourgeois ◽  
Marion Loirat ◽  
Benoit Tessoulin ◽  
Elsa Lestang ◽  
Pierre Peterlin ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Cord Blood ◽  
Median Time ◽  
Conflicts Of Interest ◽  
Chronic Gvhd ◽  
Conditioning Regimen ◽  
Unrelated Donor ◽  
Single Centre ◽  
Stem Cell Source

Abstract Abstract 3108 Introduction: RIC regimens are increasingly used for allo-SCT in older patients or patients with co-morbidities. The FB2 regimen (Fludarabine 120–150 mg/m2 + I.V. Busulfan 6.4 mg/Kg + ATG 5 mg/Kg) using PBSC as stem cell source is currently the most widely used RIC regimen in many European centres. On the other hand, in patients without a suitable HLA-matched donor, the use of umbilical cord blood stem cells for allo-SCT (uCBT) is increasingly considered, especially using the RIC regimen developed by the Minneapolis group. Series comparing PBSC vs CB as stem cells source for RIC allo-SCT are still scarce and using various RIC regimens before allo-SCT. Patients and Methods: This retrospective single centre analysis compared two homogeneously treated cohorts of patients who had received between January 2007 and November 2010 in our department either a FB2/PBSC allo-SCT (n=52, males: 61%; median age: 59 years (range: 22–70)) or a FC-TBI/uCBT (Fludarabine 200 mg/m2 + Cyclophosphamide 50 mg/Kg + TBI 2 Grays regimen; n=39, males 49%; median age 56 years (range: 22–70). Except for age (p=0.03), there were no significant differences between the 2 groups regarding patients and diseases characteristics: gender (p=0.22), interval between diagnosis and transplant (PBSC: 9 months vs CB: 10 months, p=0.85), disease type (PBSC: myeloid disease 63% vs CB: 67%, p=0.75), status at transplant (complete remission PBSC: 77% vs CB: 67%, p=0.28), prior auto-SCT (PBSC: 35% vs CB: 33%, p=0.90). Donors in the PBSC group were as follows: sibling donors, n=30; HLA-MUD n=20, mismatched unrelated n=2. All patients from the CB group received 2 CB units (HLA matching 4/6 n=25; 5/6 n=53). As for GVHD prophylaxis, patients received cyclosporine (CsA) alone in case of an HLA-identical sibling donor, and CsA+ mycophenolate mofetyl in all other cases. None of the patients from the PBSC group received G-CSF after transplant, while it was administered to all CB recipients. Results: Median follow-up was respectively 19 and 20 months for the PBSC and the CB groups (p=NS). Engraftment and median time for neutrophils recovery were similar between the 2 groups: PBSC: 96% vs CB: 90%, p=0.22; and 17 days (range: 0–39) vs 16 days (range: 8–60), p=0.88, respectively. The median time for platelets recovery (&gt;20000/mm3) was significantly higher in the CB group: 38 days (range: 13–150) vs PBSC: 0 days (range: 0–186) (p&lt;0.0001). The cumulative incidences of grade II-IV and grade III-IV acute GVHD were comparable between both groups: PBSC: 31% and 15% vs CB: 26% and 8% (p=0.72 and p=0.28) as also the 2-years incidence of chronic GVHD: PBSC: 35% vs uCBT: 25%, p=0.54. 2-years NRM was significantly higher after uCBT: 26% vs 6%, p=0.02. Finally, there were no differences between the two groups in terms of 2-years OS, DFS and Relapse Incidence: PBSC: 62.3% vs CB: 60.8% (p=0.51); 58.7% vs 50.4% (p=0.43) and 36% vs 23% (p=0.31). In multivariate analysis, the source of stem cells (CB) remains associated with NRM (HR: 0.16, 95%CI: 0.05–0.5, p=0.001) but was not predictable for survivals. Conclusion: Our study suggests that RIC uCBT is a valid alternative in patients lacking an HLA-matched related or unrelated donor and candidate for RIC allo-SCT. Prospective and randomized studies are warranted in order to establish the definitive role of uCBT, especially in patients with acute leukemia, where CB cells may offer a rapidly available source of stem cells in diseases with high tumor kinetics. Disclosures: No relevant conflicts of interest to declare.

Survival after transplantation of unrelated donor umbilical cord blood is comparable to that of human leukocyte antigen–matched unrelated donor bone marrow: results of a matched-pair analysis

Blood ◽  
2001 ◽  
Vol 97 (10) ◽  
pp. 2957-2961 ◽  
Author(s):  
Juliet N. Barker ◽  
Stella M. Davies ◽  
Todd DeFor ◽  
Norma K. C. Ramsay ◽  
Daniel J. Weisdorf ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Human Leukocyte Antigen ◽  
Cord Blood ◽  
Umbilical Cord Blood ◽  
Human Leukocyte ◽  
Matched Pair ◽  
Unrelated Donor ◽  
Leukocyte Antigen ◽  
Matched Pair Analysis ◽  
Pair Analysis

Abstract Umbilical cord blood (UCB) is being increasingly used for hematopoietic stem cell transplantation and has been associated with a reduced incidence of severe graft-versus-host disease (GVHD). To further investigate the relative merits of unrelated donor UCB versus bone marrow (BM), a matched-pair analysis comparing the outcomes of recipients of 0 to 3 human leukocyte antigen (HLA)–mismatched UCB and HLA-A, B, DRB1-matched BM was performed. UCB patients, who received cyclosporine (CSA) and methylprednisolone (MP), were matched for age, diagnosis, and disease stage with BM patients, who received either methotrexate (MTX) and CSA (26 pairs) or T-cell depletion (TCD) and CSA/MP (31 pairs). Patients were predominantly children (median age, 5 years) undergoing transplantation for malignancy, storage diseases, BM failure, and immunodeficiency syndromes between 1991 and 1999. Although neutrophil recovery was significantly slower after UCB transplantation, the probability of donor-derived engraftment at day 45 was 88% in UCB versus 96% in BM-MTX recipients (P = .41) and 85% in UCB versus 90% in BM-TCD recipients (P = .32), respectively. Platelet recovery was similar in UCB versus BM pairs. Furthermore, incidences of acute and chronic GVHD were similar in UCB and BM recipients, with 53% of UCB versus 41% of BM-MTX recipients alive (P = .40) and 52% of UCB versus 56% of BM-TCD recipients alive at 2 years (P &gt; .80), respectively. These data suggest that despite increased HLA disparity, probabilities of engraftment, GVHD, and survival after UCB transplantation are comparable to those observed after HLA-matched BM transplantation. Therefore, UCB should be considered an acceptable alternative to HLA-matched BM for pediatric patients.

scholarly journals Use of alternative donors for allogeneic stem cell transplantation

Hematology ◽  
2015 ◽  
Vol 2015 (1) ◽  
pp. 220-224 ◽  
Author(s):  
Claudio Anasetti
Keyword(s):  
Clinical Trials ◽  
Stem Cell ◽  
Cord Blood ◽  
Graft Failure ◽  
Cord Blood Transplantation ◽  
Human Leukocyte ◽  
Unrelated Donor ◽  
Factors Affecting ◽  
Blood Transplantation ◽  
Cell Sources

Abstract For patients without a human leukocyte antigen (HLA)-matched sibling or unrelated donor, options include transplantation from HLA-mismatched related donors, HLA-mismatched unrelated donors, or unrelated cord blood units. Graft failure remains a problem in 10%-20% of cord blood transplants that contain a limited number of hematopoietic cells. Many approaches are tested in clinical trials to offset the risk of graft failure after cord blood transplantation. GVHD remains a hurdle with any HLA mismatched graft. The use of post-transplant cyclophosphamide holds the promise to overcome the HLA barrier and prevent GVHD despite donor mismatch for a full HLA haplotype. Priority should be given to enrolling patients onto transplant protocols addressing the fundamental problems of engraftment, GVHD, relapse or treatment-related mortality tested with one or more of the alternative stem cell sources. Principles for prioritization of alternative stem cell sources are discussed separately for children and adults who cannot be enrolled on clinical trials. It is difficult ranking currently available sources in the face of multiple factors affecting outcomes, rapidly changing transplant technology and without results from comparative trials.

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