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Cord Blood Stem Cells

Cord blood transplants supported by co-infusion of mobilized hematopoietic stem cells from a third-party donor

Bone Marrow Transplantation volume 43, pages 365–373 (2009)Cite this article

Abstract

This open label clinical study provides updated evaluation of the strategy of single unit cord blood transplants (CBTs) with co-infusion of third-party donor (TPD) mobilized hematopoietic stem cells (MHSC). Fifty-five adults with high-risk hematological malignancies, median age 34 years (16–60 years) and weight 70 kg (43–95 kg), received CBTs (median 2.39 × 107 total nucleated cell (TNC) per kg and 0.11 × 106 CD34+ per kg) and TPD-MHSC (median 2.4 × 106 CD34+ per kg and 3.2 × 103 CD3+ per kg). Median time to ANC and to CB-ANC >0.5 × 109/l as well as to full CB-chimerism was 10, 21 and 44 days, with maximum cumulative incidences (MCI) of 0.96, 0.95 and 0.91. Median time to unsupported platelets >20 × 109/l was 32 days (MCI 0.78). MCI for grades I–IV and III–IV acute GVHD (aGVHD) were 0.62 and 0.11; 12 of 41 patients (29%) who are at risk developed chronic GVHD, becoming severely extensive in three patients. Relapses occurred in seven patients (MCI=0.17). The main causes of morbi-mortality were post-engraftment infections. CMV reactivations were the most frequent, their incidence declining after the fourth month. Five-year overall survival and disease-free survival (Kaplan–Meier) were 56 % and 47% (63% and 54% for patients ⩽40 years). In conclusion, CBT with single units of relatively low cell content and 0–3 HLA mismatches is feasible as a first choice option for adult patients who lack a readily available adequate adult donor.

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Acknowledgements

The following CB Banks are acknowledged for supplying the transplanted CB units: Barcelona (Spain), Dusseldorf (Germany), Madrid 12-Octubre (Spain), New York (US), Milan (Italy), London (UK), Valencia (Spain), Galicia (Spain), Madrid-CAM (Spain), St Louis (US), Bordeaux (France), Bensançon (France) and Arcadia (US). Also acknowledged for their cooperation are the technical and nursing staff of the Department of Hematology of Hospital Universitario Puerta de Hierro.

Prof George L Delclos MD (University of Texas, Houston, TX,USA) and Sergio Querol MD (Anthony Nolan Research Institute, London) are acknowledged for their critical review of the paper.

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Authors and Affiliations

  1. Servicio de Hematología, Universidad Autónoma de Madrid, Hospital Universitario Puerta de Hierro, Madrid, Spain

    G Bautista, J R Cabrera, C Regidor, R Forés, J A García-Marco, E Ojeda, I Sanjuán, E Ruiz, I Krsnik, B Navarro, S Gil, E Magro, A de Laiglesia, R Gonzalo-Daganzo, T Martín-Donaire, M Rico, I Millán & M N Fernández

Authors
  1. G Bautista
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  2. J R Cabrera
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  3. C Regidor
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  4. R Forés
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  5. J A García-Marco
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  6. E Ojeda
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  7. I Sanjuán
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  8. E Ruiz
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  9. I Krsnik
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  10. B Navarro
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  11. S Gil
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  12. E Magro
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  13. A de Laiglesia
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  14. R Gonzalo-Daganzo
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  15. T Martín-Donaire
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  17. I Millán
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  18. M N Fernández
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Corresponding author

Correspondence to M N Fernández.

Additional information

Funding: Grants from EC (AlloStem IP, contract No 503319), Spanish FIS (PI03/0961 & PI04/2794), Spanish Government (SAF 2002-12793E & SAF 2004/0037E), Comunidad Autónoma de Madrid (SAF 2005-04552), Gabrielle Rich Leukemia Foundation, Vidacord and AlloStem-AirProducts Universidad Autónoma de Madrid Chair.

Redundant publications: Preliminary results on the first 27 patients is published earlier.3

Disclosure The authors state no conflict of interest.

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Bautista, G., Cabrera, J., Regidor, C. et al. Cord blood transplants supported by co-infusion of mobilized hematopoietic stem cells from a third-party donor. Bone Marrow Transplant 43, 365–373 (2009). https://doi.org/10.1038/bmt.2008.329

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