Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Emergency double unrelated umbilical cord blood transplant for acute lymphoblastic leukemia after very late deferral of bone marrow donor

Bone Marrow Transplantation volume 41, pages 675–676 (2008)Cite this article

Our transplant center was asked to evaluate a 44-year-old African American man with Philadelphia chromosome-positive ALL in first remission. Allogeneic blood or marrow transplantation was recommended. He had no HLA-matched siblings, therefore a search for matched unrelated donors was initiated through the National Marrow Donor Program. No suitable matches were identified while he remained in remission receiving chemotherapy, and imatinib mesylate. Acute leukemia relapsed 8 months later, and was refractory to chemotherapy although a hematological remission was achieved with dasatinib. By that time, a suitable unrelated donor (donor A), who had sickle cell trait, had been identified. The alternative options were an HLA-DR antigen-mismatched adult donor and two unrelated umbilical cord blood units (5/6 and 6/6 antigen matched, but each with an insufficient cell count to be used as the sole product). The patient was CMV seronegative; his and the donor HLA types are shown in Table 1.

Table 1 HLA types of patient and available hematopoietic stem cell grafts
Full size table

Conditioning for transplant consisted of fractionated TBI (1320 cGy; 11 fractions) and VP-16 (60 mg/kg). On the second day of treatment, after the patient had already received a myeloablative radiation dose of 720 cGy, the transplant center was notified that the donor would no longer be available. It was therefore decided that the two unrelated cord blood units, UCBa and UCBb, would be used in combination as the stem cell graft. The conditioning therapy was altered to a regimen of 1320 cGy TBI, followed by 25 mg/m2 fludarabine daily for 3 days with 60 mg/kg cyclophosphamide on each of the last 2 days. Cyclosporin and mycophenolate were started on day 1. Cord blood unit UCBb was infused on day 0, within 6 days of the request by National Marrow Donor Program. As this infusion was complicated by the development of malignant hypertension, FK-506 was substituted for cyclosporine and the infusion of the second cord blood unit was delayed until the next day. G-CSF and the usual supportive care were given.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. The National Donor Search Project: Search Statistics and Demographic Data 2004 cited; Available from: http://www.marrow.org/ABOUT/Publications/2004_Biennial_Report/PDF/biennial_report_2004_2.pdf.

  2. Barker JN, Krepski TP, DeFor TE, Davies SM, Wagner JE, Weisdorf DJ . Searching for unrelated donor hematopoietic stem cells: availability and speed of umbilical cord blood versus bone marrow. Biol Blood Marrow Transplant 2002; 8: 257–260.

    Article  Google Scholar 

  3. Fernandes J, Rocha V, Robin M, de Latour RP, Traineau R, Devergie A et al. Second transplant with two unrelated cord blood units for early graft failure after haematopoietic stem cell transplantation. Br J Haematol 2007; 137: 248–251.

    Article  PubMed  Google Scholar 

  4. Nagayama H, Misawa K, Tanaka H, Ooi J, Iseki T, Tojo A et al. Transient hematopoietic stem cell rescue using umbilical cord blood for a lethally irradiated nuclear accident victim. Bone Marrow Transplant 2002; 29: 197–204.

    Article  CAS  PubMed  Google Scholar 

  5. Baranov A, Gale RP, Guskova A, Piatkin E, Selidovkin G, Muravyova L et al. Bone marrow transplantation after the Chernobyl nuclear accident. N Engl J Med 1989; 321: 205–212.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Table 2 is derived from the data published by the National Marrow Donor Program.1

Author information

Authors and Affiliations

  1. City of Hope-Banner Bone Marrow Transplant Program, Phoenix, AZ, USA

    C Sarkodee-Adoo, J Alvarnas, A Briggs, J Schriber, C Karanes, A Nademanee, R Chiffelle, R Gach, G Sulski, A Rakkar & S Forman

Authors
  1. C Sarkodee-Adoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J Alvarnas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A Briggs
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J Schriber
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C Karanes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A Nademanee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R Chiffelle
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. R Gach
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. G Sulski
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. A Rakkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. S Forman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C Sarkodee-Adoo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sarkodee-Adoo, C., Alvarnas, J., Briggs, A. et al. Emergency double unrelated umbilical cord blood transplant for acute lymphoblastic leukemia after very late deferral of bone marrow donor. Bone Marrow Transplant 41, 675–676 (2008). https://doi.org/10.1038/sj.bmt.1705949

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.bmt.1705949

This article is cited by

Search

Advanced search

Quick links