scholarly journals Umbilical Cord Blood Is the Most Significant Risk Factor for the Development of Bloodstream Infection after Allogeneic Hematopoietic Cell Transplantation

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1905-1905
Author(s):  
Shinsuke Takagi ◽  
Hideki Araoka ◽  
Naoyuki Uchida ◽  
Masahiro Abe ◽  
Mitsuhiro Yuasa ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Cumulative Incidence ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Allogeneic Hct ◽  
The Impact ◽  
Donor Source

Abstract Background: Bloodstream infection (BSI) is one of serious complications after allogeneic hematopoietic cell transplantation (HCT). Several risk factors have been described in previous reports. They included elderly patients, myeloid malignancies, myeloablative conditioning and HLA mismatch. In recent years, the number of umbilical cord blood used as an alternative donor source is rapidly increasing. The interval between transplant and neutrophil engraftment after umbilical cord blood transplantation (UCBT) is longer than that of other stem cell sources, and bacterial infections are one of the most serious concerns after UCBT. However, studies that focus on the impact of donor source on the incidence of BSI and include sufficient number of UCBT are lacking. In the study, we aimed to analyze the impact of umbilical cord blood on the development of BSI after allogeneic HCT retrospectively. Patient and Method: We retrospectively studied the patients who received transplant as first allogeneic HCT in Toranomon Hospital between Apr 2003 and Mar 2014. We analyzed the incidence of BSI that occurred within 100 days after transplant. BSI was defined as isolation of a bacterial or fungal pathogen from at least 1 blood culture, with the exception of coagulase-negative staphylococci (CNS) and normal contaminants (Corynebacterium species, Lactobacillus species, Bacillus species and Propionibacterium species), which required 2 separate blood cultures with the same antibiogram, to be considered a true infection. BSI was considered polymicrobial, if 2 or more pathogens were isolated in a single blood culture. The patients whose blood culture was positive within 2 weeks before transplant and the patients whose performance status (PS) were 4 before transplant were excluded. Result: A total of 1032 patients were extracted. Donors were related peripheral blood stem cell and/or bone marrow (r-PB/BM) in 155 patients, unrelated BM (ur-BM) in 243, and unrelated umbilical cord blood (ur-CB) in 634. The median age of recipient was 49 years (range, 16 - 82). Underlying diseases were as follows; AML (n=458), MDS (n=83), CML (n=30), MPN (n=15), MDS/MPN (n=13), ALL/LBL (n=134), CLL (n=3), AUL (n=9), NHL (n=162), HL (n=17), ATL (n=53), MM (n=16), AA (n=35) and others (n=4). The cumulative incidence of BSI was 47.6% (95% confidence interval, 44.5 - 50.6%) at 100 days after allogeneic HCT. The median onset of first BSI was day 7 (range, 0 - 99) after transplant. In 491 patients who developed BSI, a single pathogen was isolated in 409 patients (gram-positive cocci: GPC in 257, gram-negative rod: GNR in 112, gram-positive rod: GPR in 31, fungus in 9). Of the 491 patients with BSI, two pathogens were isolated in 74 patients (two GPCs in 37, one GPC & one GNR in 20, one GPC & one GPR in 13, two GNRs in 3, one GNR & one GPR in 1) and three pathogens were isolated in 8 patients (three GPCs in 5, two GPCs & one GNR in 1, two GPCs & one GPR in 1, one GPC & two GNRs in 1). Of the 581 isolates, GPCs accounted for 66%. The most frequent isolates in GPCs and GNRs were Staphylococcus epidermidis (34% in GPCs) and Pseudomonas aeruginosa (33% in GNRs), respectively. The cumulative incidence of BSI after transplants from r-PB/BM, ur-BM, ur-CB was 31.7%, 35.0%, 56.3%, respectively (p<0.01). In univariate analysis, age (>49 vs. ≤49, p<0.01), PS (2-3 vs. 0-1, p<0.01), hematologic disease (myeloid vs. others, p=0.01), disease status (not in CR vs. in CR, p<0.01), conditioning regimen (MAC vs. RIC, p<0.01), donor source (ur-CB vs. rPB/BM and ur-BM, p<0.01) had impact on the cumulative incidence of BSI. In multivariate analysis, ur-CB was identified as the most significant risk factor for the development of BSI (hazard ratio 1.60, 95% confidence interval 1.34 - 1.92, p=0.00000017). Conclusion: The study included 634 UCBT and it allowed us to clarify the impact of umbilical cord blood on the development of BSI. We concluded that umbilical cord blood was the most significant risk factor for BSI after allogeneic HCT. BSI should be recognized as a serious complication that emerges in more than a half of recipients in the early phase after UCBT. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Umbilical cord blood therapy modulates neonatal hypoxic ischemic brain injury in both females and males

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tayla R. Penny ◽  
Yen Pham ◽  
Amy E. Sutherland ◽  
Joohyung Lee ◽  
Graham Jenkin ◽  
...  
Keyword(s):  
Brain Injury ◽  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Significant Risk ◽  
Immunohistochemical Analysis ◽  
Significant Risk Factor ◽  
Tissue Loss ◽  
Artery Ligation ◽  
Rat Pups

AbstractPreclinical and clinical studies have shown that sex is a significant risk factor for perinatal morbidity and mortality, with males being more susceptible to neonatal hypoxic ischemic (HI) brain injury. No study has investigated sexual dimorphism in the efficacy of umbilical cord blood (UCB) cell therapy. HI injury was induced in postnatal day 10 (PND10) rat pups using the Rice-Vannucci method of carotid artery ligation. Pups received 3 doses of UCB cells (PND11, 13, 20) and underwent behavioural testing. On PND50, brains were collected for immunohistochemical analysis. Behavioural and neuropathological outcomes were assessed for sex differences. HI brain injury resulted in a significant decrease in brain weight and increase in tissue loss in females and males. Females and males also exhibited significant cell death, region-specific neuron loss and long-term behavioural deficits. Females had significantly smaller brains overall compared to males and males had significantly reduced neuron numbers in the cortex compared to females. UCB administration improved multiple aspects of neuropathology and functional outcomes in males and females. Females and males both exhibited injury following HI. This is the first preclinical evidence that UCB is an appropriate treatment for neonatal brain injury in both female and male neonates.

scholarly journals Maternal Obesity and Rectovaginal Group B Streptococcus Colonization at Term

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Shelby M. Kleweis ◽  
Alison G. Cahill ◽  
Anthony O. Odibo ◽  
Methodius G. Tuuli
Keyword(s):  
Risk Factor ◽  
Maternal Obesity ◽  
Management Strategies ◽  
Group B Streptococcus ◽  
Significant Risk ◽  
Positive Culture ◽  
Significant Risk Factor ◽  
Entire Cohort ◽  
Group B ◽  
The Impact

Objective. To test the hypothesis that maternal obesity is an independent risk factor for rectovaginal group B streptococcus (GBS) colonization at term.Study Design. Retrospective cohort study of consecutive women with singleton term pregnancies admitted in labor at Barnes-Jewish Hospital (2004–2008). Maternal BMI ≥ 30 Kg/m2(obese) or <30 Kg/m2(nonobese) defined the two comparison groups. The outcome of interest was GBS colonization from a positive culture. Baseline characteristics were compared using Student’st-test and Chi-squared or Fisher’s exact test. The association between obesity and GBS colonization was assessed using univariable and multivariable analyses.Results. Of the 10,564 women eligible, 7,711 met inclusion criteria. The prevalence of GBS colonization in the entire cohort was relatively high (25.8%). Obese gravidas were significantly more likely to be colonized by GBS when compared with nonobese gravidas (28.4% versus 22.2%,P<0.001). Obese gravidas were still 35% more likely than nonobese women to test positive for GBS after adjusting for race, parity, smoking, and diabetes (adjusted OR 1.35 [95% CI 1.21–1.50]).Conclusion. Maternal obesity is a significant risk factor for GBS colonization at term. Further research is needed to evaluate the impact of this finding on risk-based management strategies.

The impact of birth anesthesia on the parameters of oxygenation and acid–base balance in umbilical cord blood

2019 ◽  
Vol 33 (20) ◽  
pp. 3445-3452 ◽  
Author(s):  
Paweł Szymanowski ◽  
Wioletta Katarzyna Szepieniec ◽  
Marcin Zarawski ◽  
Paweł Gruszecki ◽  
Hanna Szweda ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Acid Base Balance ◽  
Acid Base ◽  
Base Balance ◽  
The Impact

Impact On Mother-Baby Parameters in Total Nuclear and CD34+ Cell Count in Umbilical Cord Blood Banking.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3221-3221
Author(s):  
Christian Villanueva ◽  
John Pando ◽  
Patricia Saenz ◽  
Hugo Rios ◽  
Maria Márquez ◽  
...  
Keyword(s):  
Cord Blood ◽  
Vaginal Delivery ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Physiological Parameters ◽  
Blood Banking ◽  
Cd34 Cells ◽  
Term Delivery ◽  
Cord Blood Banking ◽  
The Impact

Abstract Abstract 3221 Poster Board III-158 Introduction Umbilical cord blood (UCB) has become an easily, available and viable source of hematopoeitic stem cells for transplant. The main limitation factor for its wide use is cell dose. Previous studies have showed that certain physiological parameters pertaining to either the baby or the mother impact in the UCB cell yields. Objectives The aim of our study was to compare five physiological parameters pertaining to the mother or baby (mother`s age [MA], gestational age at delivery [GA], baby`s gender [G], baby`s birth weight [BW] and type of delivery [TD]) with total nuclear cells (TNC) and CD34 + cells recovery. We also evaluated the impact of time from collection to processing (TCP) on CD45+ cells viability. Methods UCB product collection was performed after the baby's delivery, while the placenta was still in uterus, either from vaginal or cesarean deliveries. Collection bags that were used contained 35 mL of CFDA-1 (CFD with Adenina) as anticoagulant. Cord blood units (CBU) were processed in our institution under local and international regulations regarding cord blood banking. Usual techniques with HES 6% for red cell depletion and 4°C centrifugation for plasma depletion were used. Twenty-five ml, EVA, two-compartment cord blood cells freezing bags (Pall Medical) were used for a final CBU volume of 20.5 ml combined with Dextran 40/40 and DMSO for cryopreservation. A sample was removed for flow cytometric analysis (BD FACSCan) and to determine the TNC (Cell-dyn 1200). Cultures pre and post CBU handling were done. Freezing took place in a controlled-rate freezer according to standard protocol before storage in liquid nytrogen. Results From May 2004 to Jun 2009, a total of 4,262 continous UCB collections were performed in our institution throught the Peruvian Republic. Seventy-eight percent of the CBU were collected by cesarean; median TCP was 30 hours 58 minutes. The mean CBU volume and TNC count were 81.8 ml and 8.63 × 108 respectively. The colected volume was greater in cesarean than vaginal delivery (85.3 ml vs 78.9, F=30.82, p<0.001). TNC counts collected were directly correlated with GA: in preterm delivery (<37sem) was 7.13×108, in term delivery (>=37sem) was 9.93×108. TNC counts were directly correlated with BW (F=325, p<0.001) while the MA had inverse correlation (F=8.05, p=0.005); regarding TD there was a significant mayor TNC count in the vaginal vs. cesarean group (10.49×108 vs. 9.22×108, F=48.207, p<0.001); while it was a trend for major TNC count in females vs. males babies (9.82×108 vs. 9.13×108, p=0.059). CD34+ cells count was directly correlated with BW (F=70.1, p<0.001). The strongest correlation was with GA (in preterm: 61.99 CD34+/ul and in term delivery: 84.67 CD34+/ul, F=27.62 p=<0.001); moreover, there was association between CD34+ cells count with TD (vaginal: 87.88 CD34+/ul vs cesarean: 80.26 CD34+/ul, F=5.327 p=0.02). There was not association either with G (females: 79.97 CD34+/ul vs males: 83.48 CD34+/ul, F=1.668 p=0.197) neither MA (F=1.82, p=0.177). There was a significant difference between CD34+ viability cells among CBU with less than 48 hours or more of TCP (99.6% vs. 99.4%, p=0.019); this difference was stronger when the CD45+ viability was evaluated (93.35% vs. 90.14%, p<0,001). Conclusions TNC and CD34+ UCB cells are influenced by many variables related to the mother and the baby. It looks like on time female babies with good weight, born to a younger mother and from a vaginal delivery reach highest TNC count. CD34+ cells count was directly correlated with BW and CD34+ viability is mainly influenced by the time from collection to processing Disclosures No relevant conflicts of interest to declare.

Allele Matching At HLA-C or DRB1 Is Associated with Improved Survival After Reduced Intensity Double Umbilical Cord Blood Transplantation

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2010-2010 ◽  
Author(s):  
Alfred L. Garfall ◽  
Haesook T Kim ◽  
Corey Cutler ◽  
Vincent T Ho ◽  
John Koreth ◽  
...  
Keyword(s):  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Cord Blood Transplantation ◽  
Umbilical Cord Blood Transplantation ◽  
Unit Selection ◽  
Blood Transplantation ◽  
Number Of Patients ◽  
The Impact ◽  
Reduced Intensity

Abstract Abstract 2010 Mismatch at HLA-C has been associated with increased transplant-related mortality in unrelated bone marrow and peripheral blood stem cell transplantation as well as single myeloablative umbilical cord blood transplantation (UCBT) in children, but the impact of HLA-C mismatch in adult double reduced-intensity conditioning (RIC) UCBT is unknown. Matching at HLA-C is not routinely considered in cord unit selection. We studied the effect of HLA-C matching in 125 patients who underwent double UCBT for hematologic malignancy at Dana-Farber Cancer Institute and Massachusetts General Hospital from 2003 through 2010. The median age was 49 years (range 16–69), and the diagnoses included acute leukemia (45%), MDS (12%), lymphoma (27%), myeloproliferative neoplasms (2%), and others (13%). Data on HLA-C match were recorded but not used in the UCB unit selection strategy. UCB unit selection criteria were a 4/6 allele level A, B, DR match with the patient and other UCB unit. 82% of patients received a fludarabine/melphalan/antithymocyte globulin RIC, and 62% received sirolimus-based graft vs host disease (GVHD) prophylaxis. The median follow-up time among survivors was 32 months (range 6–73). The degree of allele matching at HLA-C (donor to both cords) was 0/4 in 14 patients (11%), 1/4 in 21 patients (17%), 2/4 in 62 patients (50%), 3/4 in 20 patients (16%), and 4/4 in 8 patients(6.4%). Patients who received 2 UCB units both with > 6/8 match at HLA-A,-B,-C, and -DRB1 had improved survival (3 year overall survival (OS) 56% vs 29%, p= 0.01). There was a significant correlation between degree of matching at HLA-C and the frequency of neutrophil engraftment (ANC > 500 by day 42) (0/4=79%, 1/4=76%, 2/4=71%, 3/4=80%, 4/4=100%; p=0.004). Similarly, matching at HLA-C was significantly correlated with platelet engraftment (plt>20,000 by day 100) (0/4=50%, 1/4=52%, 2/4=57%, 3/4=70%, 4/4=100%; p=0.0004). Matching at HLA-A,-B, or –DRB1 did not correlate with engraftment. There was no effect of matching at HLA-C on relapse, acute GVHD, or chronic GVHD. A full match at HLA-C (4 alleles) was associated with improved survival (3-year OS 67% vs 33% with less than full match, p=0.05) but there only 8 patients who received 2 HLA-C matched UCB units. Degree of match individually at HLA-A,-B, or DRB1 was not alone associated with survival. When various combinations of match were examined, full matching at either HLA-C or full matching at HLA-DRB1 (with less than full matching at HLA-C), compared to full matching at neither locus, was associated with improved 3-year OS (67% vs. 42% vs. 24%, p=0.03). HLA-C match did not predict the dominant UCB unit. In summary, (1) patients who received closer HLA allele-level matched UCB units had improved survival after RIC double UCBT; (2) matching at HLA-C in RIC double UCBT may be associated with earlier neutrophil and platelet engraftment; (3) survival may be improved when patients received UCB units fully matched at HLA-C or fully matched at HLA-DRB1 (if less than fully matched at HLA-C) compared to recipients of units fully matched at neither locus; and (4) matching at HLA-A,-B, or DRB1 alone did not correlate with differences in engraftment or survival. These data are limited by the small number of patients that were compatible at HLA-C but warrant examination in a larger cohort to determine the role of matching at HLA-C in UCB unit selection algorithms. Disclosures: Soiffer: Genzyme: Consultancy; Fresenius biotech: Research Funding; Miltenyi Biotech: Consultancy.

scholarly journals Human Cord Blood Serum-Derived APP α-Secretase Cleavage Activity is Mediated by C1 Complement

2018 ◽  
Vol 27 (4) ◽  
pp. 666-676 ◽  
Author(s):  
Ahsan Habib ◽  
Darrell Sawmiller ◽  
Huayan Hou ◽  
Manasa Kanithi ◽  
Jun Tian ◽  
...  
Keyword(s):  
Amyloid Precursor Protein ◽  
Blood Serum ◽  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Precursor Protein ◽  
Human Umbilical Cord ◽  
Amyloid Β Peptide ◽  
Cord Blood Serum ◽  
The Impact

Alzheimer’s Disease (AD) is the leading cause of dementia in the elderly. In healthy individuals, amyloid precursor protein (APP) is cleaved by α-secretase, generating soluble α-amyloid precursor protein (sAPPα), which contributes neuroprotective functions in the neuronal environment. In contrast, in the neurodegenerative environment of AD patients, amyloid-β-peptide (Aβ) of either 40 or 42 residues are generated by increased activity of β- and γ-secretase. These proteins amalgamate in specific regions of the brain, which disrupts neuronal functions and leads to cognitive impairment. Human umbilical cord blood cells (HUCBC) have proven useful as potential immunomodulatory therapies in various models of neurodegenerative diseases, including AD. Our most recent work studied the impact of umbilical cord blood serum (CBS) on modulation of sAPPα production. Heat-sensitive CBS significantly promoted sAPPα production, indicating that heat-sensitive factor(s) play(s) a role in this process. Liquid chromatography with tandem mass spectrometry (LC-MS/MS) analysis was used to determine the molecular source of α-secretase in purified CBS and aged blood serum (AgBS) fraction. Of the proteins identified, the subunits of C1 complex (C1q, C1r, and C1s) and alpha-2-macroglobulin showed significantly greater levels in purified α-CBS fraction (α-CBSF) compared with the AgBS fraction (AgBSF). Specifically, C1 markedly increased sAPPα and alpha-carboxyl-terminal fragment (α-CTF) production in a dose-dependent fashion, whereas C1q alone only minimally increased and C3 did not increase sAPPα production in the absence of sera. Furthermore, C1q markedly increased sAPPα and α-CTF, while decreasing Aβ, in CHO/APPwt cells cultured in the presence of whole sera. These results confirm our initial assumption that APP α-secretase activity in human blood serum is mediated by complement C1, opening a potential therapeutic modality for the future of AD.

The impact of intrapartum factors on umbilical cord blood stem cell banking

2003 ◽  
Vol 31 (4) ◽  
Author(s):  
U. Aufderhaar ◽  
W. Holzgreve ◽  
E. Danzer ◽  
A. Tichelli ◽  
C. Troeger ◽  
...  
Keyword(s):  
Stem Cell ◽  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Blood Stem Cell ◽  
Cord Blood Stem Cell ◽  
Cell Banking ◽  
Stem Cell Banking ◽  
The Impact ◽  
Intrapartum Factors

scholarly journals Adult Umbilical Cord Blood Transplantation Using Myeloablative Total Body Irradiation, Fludarabine, and Thiotepa Conditioning

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3395-3395
Author(s):  
Sarah Anand ◽  
Samantha Thomas ◽  
Kelly Corbet ◽  
Cristina Gasparetto ◽  
Richard Lopez ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Cumulative Incidence ◽  
Cord Blood Transplantation ◽  
Chronic Gvhd ◽  
Treatment Related Mortality ◽  
Related Mortality ◽  
Neutrophil Engraftment

Abstract Introduction: Umbilical cord blood (UCB) extends the curative potential of stem cell transplantation to adult patients without a suitable donor. The most commonly used myeloablative preparative regimen results in an unacceptably high 6-month treatment related mortality rate of approximately 32% (Barker J et al. Br J Haematol. 2015). In an attempt to reduce treatment related mortality, we piloted a modified myeloablative regimen with total body irradiation (TBI), fludarabine, and thiotepa. We report clinical outcomes from a cohort of patients who received single or double UCBT after conditioning with this regimen. Methods: Thirty-one consecutive adult patients ≥ 18 years old with hematologic malignancies who underwent single or double umbilical cord blood transplantation at Duke University from 2010 to 2015 were included in this study. The conditioning regimen consisted of thiotepa 5 mg/kg/day i.v. x 2 days (days -11 to -10), TBI 150 cGy twice a day for total nine fractions (1350 cGy days -9 to -5), and fludarabine 40 mg/m2/day i.v. x 4 days (days -5 to -2). Cord blood units were matched to the recipient at 4 or more HLA loci (intermediate-resolution for A and B, high-resolution for DRB1). Graft versus host disease (GVHD) prophylaxis was with tacrolimus (target level 10-15 ng/ml) and mycophenolate mofetil 1000 mg TID. Antimicrobial prophylaxis and supportive care measures including GCSF administration until ANC > 1000 were conducted per institutional protocol. Probabilities of neutrophil and platelet recovery, acute and chronic GVHD, and treatment-related mortality were estimated by the cumulative incidence method. Relapse-free and overall survival rates were estimated by the Kaplan-Meier method. Results: Thirty-one patients (median age 46 years; range, 19-65) with hematologic malignancies were evaluated. Twenty-four patients (77%) had acute leukemia or myelodysplastic syndrome, while 7 patients (23%) had non-Hodgkin's lymphoma or multiple myeloma. By the "Disease Risk Index" (Armand P et al. Blood. 2014), 20 patients (65%) had low or intermediate risk disease, while 11 patients (35%) had high or very high risk disease. 30 patients underwent double UCB and 1 patient received single UCB transplantation. The median cryopreserved total nucleated cell dose was 5.4 x 107/kg (range: 3.2-8.4 x 107/kg). The cumulative incidence of neutrophil engraftment was 90% (95% CI, 82%-99%; Figure 1) at a median time of 21 days (95% CI, 19-26). Three patients did not have neutrophil engraftment; two patients had early death at days 7 and 14 prior to engraftment, while one patient had graft failure requiring second transplant. The cumulative incidence of platelet engraftment was 86% (95% CI, 75%-97%) at a median time of 47 days (95% CI, 37-73). Cumulative incidences of grades II-IV and grades III-IV acute GVHD were 48% (95% CI, 34%-69%) and 10% (95% CI, 3%-28%), respectively. The overall incidence of chronic GVHD was 40% (95% CI, 27%-59%), with 17% (95% CI, 8%-37%) of patients experiencing moderate to severe chronic GVHD. Treatment-related mortality at 6 months was 13% (Figure 2), while at 1 year and 3 years was 27% and 33%, respectively. With a median follow-up of 35.5 months (95% CI, 12.7-52.2), disease-free and overall survival at 3 years was 51% (95% CI, 29%-69%) and 57% (95% CI, 36%-73%), respectively. Conclusion: UCB transplantation with the modified myeloablative conditioning regimen of TBI, fludarabine, and thiotepa results in reliable neutrophil engraftment with reduced early treatment related mortality as compared to standard myeloablative conditioning consisting of TBI, fludarabine, and cyclophosphamide. It provides a promising disease-free and overall survival in an older (median age 46), heterogeneous patient population. This regimen represents a reasonable alternative to standard conditioning with TBI, fludarabine, and cyclophosphamide and warrants further study. Figure 1 Figure 1. Figure 2 Figure 2. Disclosures No relevant conflicts of interest to declare.

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