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Cord Blood Stem Cells

Preinfusion variables predict the predominant unit in the setting of reduced-intensity double cord blood transplantation

Bone Marrow Transplantation volume 41, pages 523–529 (2008)Cite this article

Abstract

Double cord blood transplantation (DCBT) may overcome the slow hematopoietic recovery and engraftment failure associated with infusion of a single cord blood unit. In DCBT, only one unit typically contributes to long-term hematopoiesis, but little is known about factors affecting cord predominance. As results from a phase I trial suggested that order of infusion may affect cord predominance, we analyzed the effect of preinfusion variables on chimerism patterns of 38 patients enrolled in the initial study and a subsequent phase II trial. All patients were treated with a reduced-intensity conditioning (RIC) regimen of fludarabine, melphalan and thymoglobulin followed by DCBT. By day 100, 66% of patients had hematopoiesis derived from a single cord blood unit. Higher post-thaw total nucleated cell and CD34+ cell dose were associated with cord predominance and in 68% of patients (P=0.03); the predominant cord blood unit was infused first. Only the post-thaw CD34+ cell dose of the predominant unit predicted time to both neutrophil and platelet engraftment. Although based on a small number of patients, our results identify parameters that may affect cord predominance and engraftment in the setting of DCBT following RIC and suggest possible strategies for selecting infusion order for cord blood units.

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Acknowledgements

This study was supported in part by the National Heart, Lung and Blood Institute (P01 HL070149).

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Authors and Affiliations

  1. Department of Pathology, Beth Israel Deaconess Medical Centre, Boston, MA, USA

    R L Haspel

  2. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

    G Kao, C Cutler, R J Soiffer, E P Alyea, V T Ho, J Koreth & J H Antin

  3. Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA

    B Y Yeap, B R Dey, S L McAfee, E C Attar, T Spitzer & K K Ballen

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  1. R L Haspel
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  2. G Kao
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  3. B Y Yeap
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  4. C Cutler
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  5. R J Soiffer
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  6. E P Alyea
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  7. V T Ho
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  8. J Koreth
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  9. B R Dey
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  10. S L McAfee
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  11. E C Attar
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  12. T Spitzer
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  13. J H Antin
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  14. K K Ballen
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Correspondence to R L Haspel.

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Haspel, R., Kao, G., Yeap, B. et al. Preinfusion variables predict the predominant unit in the setting of reduced-intensity double cord blood transplantation. Bone Marrow Transplant 41, 523–529 (2008). https://doi.org/10.1038/sj.bmt.1705933

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  • DOI: https://doi.org/10.1038/sj.bmt.1705933

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