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Unrelated Donor Transplants

Outcomes of unrelated cord blood transplantation in pediatric recipients

Bone Marrow Transplantation volume 34, pages 129–136 (2004)Cite this article

Summary:

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)+steroids±MMF (7) or CsA+methotrexate (MTX) (4); median total nucleated cells (TNC): 3.8 × 107/kg (1.1–11); median CD34+: 2.3 × 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 ⩾grade II acute graft-versus-host disease (aGVHD) by day +60 27%, ⩾grade 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.

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References

  1. Wagner JE, Rosenthal J, Sweetman R et al. Successful transplantation of HLA-matched and HLA-mismatched umbilical cord blood from unrelated donors: analysis of engraftment and acute graft-versus-host disease. Blood 1996; 88: 795–802.

    CAS  PubMed  Google Scholar 

  2. Wagner JE, Barker JN, DeFor TE et al. Transplantation of unrelated donor umbilical cord blood in 102 patients with malignant and nonmalignant diseases: influence of CD34 cell dose and HLA disparity on treatment-related mortality and survival. Blood 2002; 100: 1611–1618.

    CAS  PubMed  Google Scholar 

  3. Kurtzberg J, Laughlin M, Graham ML et al. Placental blood as a source of hematopoietic stem cells for transplantation into unrelated recipients. N Engl J Med 1996; 335: 157–166.

    Article  CAS  PubMed  Google Scholar 

  4. Cairo MS, Wagner JE . Placental and/or umbilical cord blood: an alternative source of hematopoietic stem cells for transplantation. Blood 1997; 90: 4665–4678.

    CAS  PubMed  Google Scholar 

  5. Gluckman E, Rocha V, Boyer-Chammard A et al. Outcome of cord-blood transplantation from related and unrelated donors. Eurocord Transplant Group and the European Blood and Marrow Transplantation Group. N Engl J Med 1997; 337: 373–381.

    Article  CAS  PubMed  Google Scholar 

  6. Rocha V, Wagner Jr JE, Sobocinski KA et al. Graft-versus-host disease in children who have received a cord-blood or bone marrow transplant from an HLA-identical sibling. Eurocord and International Bone Marrow Transplant Registry Working Committee on Alternative Donor and Stem Cell Sources. N Engl J Med 2000; 342: 1846–1854.

    Article  CAS  PubMed  Google Scholar 

  7. Sanz MA, Sanz GF . Unrelated donor umbilical cord blood transplantation in adults. Leukemia 2002; 16: 1984–1991.

    Article  CAS  PubMed  Google Scholar 

  8. Wernet P, Lopez J, Contreras M et al. The International NETCORD Organization for High Standard Cord Blood Banking. Blood 2002; 100: 468b (abstract 5450).

    Google Scholar 

  9. Lansdorp PM, Dragowska W, Mayani H et al. Thy-1 expression is linked to functional properties of primitive hematopoietic progenitor cells from human umbilical cord blood. Blood 1994; 84: 36–43.

    PubMed  Google Scholar 

  10. Vaziri H, Dragowska W, Allsopp RC et al. Evidence for a mitotic clock in human hematopoietic stem cells: loss of telomeric DNA with age. Proc Natl Acad Sci USA 1994; 91: 9857–9860.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Ohnuma K, Isoyama K, Nishihira H et al. Cord blood transplantation from HLA-mismatched unrelated donors. Leukemia Lymphoma 2002; 43: 1029–1034.

    Article  PubMed  Google Scholar 

  12. Gluckman E, Locatelli F . Umbilical cord blood transplants. Exp Hematol 2000; 28: 1197–1205.

    Article  CAS  PubMed  Google Scholar 

  13. Plunkett W, Rodriguez Jr CO, Nowak BJ et al. Outcomes among 562 recipients of placental-blood transplants from unrelated donors [comment]. J Clin Oncol 1998; 16: 3607–3615.

    Article  PubMed  Google Scholar 

  14. Dupont B, Yang SY . Histocompatibility. In: Forman SJBK, Thomas ED (ed.). Bone Marrow Transplantation. Blackwell Scientific: Cambridge, MA, 1994, 22–40.

    Google Scholar 

  15. Petersdorf EW, Smith AG, Haase AM et al. Polymorphism of HLA-DRw52-associated DRB1 genes as defined by sequence-specific oligonucleotide probe hybridization and sequencing. Tissue Antigens 1991; 38: 169–177.

    Article  CAS  PubMed  Google Scholar 

  16. Bessmertny O, Harrison L, Osunkwo I et al. Significant alteration of mycophenolate mofetil pharmacokinetics in pediatric allogeneic stem cell transplant (alloSCT) recipients: alternate dosing is required in alloSCTs vs solid organ allograft recipients. Blood 2002; 100: 4188 (abstract).

    Google Scholar 

  17. Glucksberg H, Storb R, Fefer A et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation 1974; 18: 295–304.

    Article  CAS  PubMed  Google Scholar 

  18. Rubinstein P, Dobrila L, Rosenfield RE et al. Processing and cryopreservation of placental/umbilical cord blood for unrelated bone marrow reconstitution. Proc Natl Acad Sci USA 1995; 92: 10119–10122.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Fraser JK, Cairo MS, Wagner EL et al. Cord blood transplantation study (COBLT): cord blood bank standard operating procedures [comment]. J Hematother 1998; 7: 521–561.

    Article  CAS  PubMed  Google Scholar 

  20. Osunkwo I, Cooney E, Bessmertny O et al. Liposomal amphotericin B (AMB) prophylaxis is safe and effective in preventing invasive fungal infections (IFI) in related and unrelated allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2003; 9: 34 (abstract).

    Article  Google Scholar 

  21. Shereck E, Bessmertny O, Cairo MS et al. Cytomegalovirus (CMV) prophylaxis with alternate day gancyclovir/foscarnet in at risk pediatric allogeneic stem cell transplant (AlloSCT) recipients is 100% effective in preventing CMV infections and reducing gancyclovir hematopoietic toxicity. Blood 2002; 100: 627a (abstract).

    Article  Google Scholar 

  22. Collett D . Modelling Survival Data in Medical Research, 1st edn. Chapman & Hall: London, New York, 1994, 40–44.

    Book  Google Scholar 

  23. Laughlin MJ, Barker J, Bambach B et al. Hematopoietic engraftment and survival in adult recipients of umbilical-cord blood from unrelated donors. N Engl J Med 2001; 344: 1815–1822.

    Article  CAS  PubMed  Google Scholar 

  24. Thomson BG, Robertson KA, Gowan D et al. Analysis of engraftment, graft-versus-host disease, and immune recovery following unrelated donor cord blood transplantation. Blood 2000; 96: 2703–2711.

    CAS  PubMed  Google Scholar 

  25. McGlave PB, DeFor TE, Miller JS et al. Unrelated donor marrow transplantation for chronic myelogenous leukemia: 9 years’ experience of the national marrow donor program. Bone Marrow Transplant 2000; 26: 723–728.

    Article  PubMed  Google Scholar 

  26. Hansen JA, Gooley TA, Martin PJ et al. Bone marrow transplants from unrelated donors for patients with chronic myeloid leukemia. N Engl J Med 1998; 338: 962–968.

    Article  CAS  PubMed  Google Scholar 

  27. Schiller G, Feig SA, Territo M et al. Treatment of advanced acute leukaemia with allogeneic bone marrow transplantation from unrelated donors. Br J Haematol 1994; 88: 72–78.

    Article  CAS  PubMed  Google Scholar 

  28. Barker JN, Weisdorf DJ, DeFor TE et al. Rapid and complete donor chimerism in adult recipients of unrelated donor umbilical cord blood transplantation after reduced-intensity conditioning. Blood 2003; 102: 1915–1919.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This work was supported in part by the Pediatric Cancer Research Foundation, Triple C Foundation, Swim Across America and Children's Medical Care Foundation (JS). We thank the nursing staff on 5Tower (Inpatient) and Irving 7 (Outpatient) and the Pediatric BMT Team at the Morgan Stanley Children's Hospital of New York – Presbyterian for their outstanding support and care of our patients. We also like to thank Linda Rahl for her expert editorial assistance in the preparation of this paper.

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Authors and Affiliations

  1. Department of Pediatrics, Children's Hospital of New York-Presbyterian, Herbert Irving Comprehensive Cancer Center, USA

    J Styczynski, J Garvin, G B Billote, L Harrison, K Wolownik, C Wischhover, R Hawks, M B Bradley, G Del Toro, D George, D Yamashiro, C van de Ven & M S Cairo

  2. Department of Pediatric Hematology and Oncology, Medical University Bydgoszcz, Poland

    J Styczynski

  3. Department of Biostatistics, Columbia University, New York, NY, USA

    Y-K Cheung

  4. Department of Medicine, Columbia University, New York, NY, USA

    D G Savage

  5. Department of Pathology, Columbia University, New York, NY, USA

    D Skerrett

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Correspondence to M S Cairo.

Additional information

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

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Styczynski, J., Cheung, YK., Garvin, J. et al. Outcomes of unrelated cord blood transplantation in pediatric recipients. Bone Marrow Transplant 34, 129–136 (2004). https://doi.org/10.1038/sj.bmt.1704537

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