Unrelated Donor Transplants

Bone Marrow Transplantation (2004) 34, 129–136. doi:10.1038/sj.bmt.1704537 Published online 26 April 2004

Outcomes of unrelated cord blood transplantation in pediatric recipients

Presented in part at the Tandem BMT Meeting, ASBMT, Keystone, Colorado, January 2003

J Styczynski1,2, Y-K Cheung3, J Garvin1, D G Savage4, G B Billote1, L Harrison1, D Skerrett5, K Wolownik1, C Wischhover1, R Hawks1, M B Bradley1, G Del Toro1, D George1, D Yamashiro1, C van de Ven1 and M S Cairo1

  1. 1Department of Pediatrics, Children's Hospital of New York-Presbyterian, Herbert Irving Comprehensive Cancer Center, USA
  2. 2Department of Pediatric Hematology and Oncology, Medical University Bydgoszcz, Poland
  3. 3Department of Biostatistics, Columbia University, New York, NY, USA
  4. 4Department of Medicine, Columbia University, New York, NY, USA
  5. 5Department of Pathology, Columbia University, New York, NY, USA

Correspondence: Professor MS Cairo, Division of Pediatric Hematology and Blood and Marrow Transplantation, Children's Hospital of New York – Presbyterian, Columbia University, 161 Fort Washington Ave., Irving 7, New York, NY 10032, USA. E-mail: mc1310@columbia.edu

Received 19 June 2003; Accepted 22 February 2004; Published online 26 April 2004.

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Abstract

We report results of unrelated cord blood transplants (UCBT) in 29 pediatric recipients in one center and the risk factors associated with survival. Median age: 9 years (0.5–20); diagnosis: ALL (9), AML (4), CML (1), HD (3), HLH (1), NHL (3), NBL (2); B-thal (1), FA (1), FEL (1), Krabbe (1), WAS (1), SAA (1); median follow-up: 11 months; conditioning: total body irradiation (TBI)-ablative (14), chemotherapy-ablative (6) and reduced intensity chemotherapy (9); GVHD prophylaxis: MMF/FK506 (18), cyclosporin A (CsA)+steroidsplusminusMMF (7) or CsA+methotrexate (MTX) (4); median total nucleated cells (TNC): 3.8 times 107/kg (1.1–11); median CD34+: 2.3 times 105/kg (0.2–9.9); and HLA match: 2 (6/6), 5 (5/6), 22 (4/6). Neutrophil engraftment by cumulative incidence curves 63% (median 28 (95% confidence interval (CI) 18–32)). Probability of greater than or equal tograde II acute graft-versus-host disease (aGVHD) by day +60 27%, greater than or equal tograde III aGVHD 20% and chronic graft-versus-host disease 3%. Estimated 1-year overall survival (OS) 46% (95% CI 30–71) and standard risk 60% (95% CI 29–100%). Variables associated with improved survival by multivariate analysis include non-TBI-ablative conditioning (P=0.024), CD34+/kg (P=0.038) and gender (P=0.048). These results suggest that CD34/kg cell dose and non-TBI-ablative conditioning may be important variables influencing OS following UCBT in pediatric recipients. Given the small number of patients, these results should be viewed cautiously.

Keywords:

UCBT, non-TBI conditioning, CD34 cell dose, GVHD, ablative conditioning