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Reduced-intensity umbilical cord blood transplant for older adult patients

Bone Marrow Transplantation volume 42, pages 685–686 (2008)Cite this article

Umbilical cord blood (UCB) transplants have been shown to produce comparable results to those obtained from mismatched unrelated bone marrow transplants for adult patients with hematologic malignancies.1, 2 Despite the less stringent HLA-matching criteria used for UCB transplants, the incidence of GVHD is acceptable1, 2 without compromising the antitumor effects.3, 4 However, most of the published studies on UCB transplants have involved primarily younger adults, with a median age of less than 40 years. Majhail et al.,5 recently addressed the role of unrelated UCB transplants for older patients and reported that the results of UCB transplants carried out in 43 adult patients older than 55 years were comparable to those obtained from 47 matched related donor transplants. The 3-year probability of progression-free survival was 34% in UCB transplants compared with 30% in matched related donor transplants and suggested that HLA-mismatched UCB could be an alternative graft source for older patients who need a transplant but do not have a matched related donor.

We have carried out an analysis of the results of older patients who have undergone reduced-intensity mismatched UCB transplant in our program. Nine older patients, median age 60 years (range 48–77 years) have received mismatched UCB; 78% of these patients received two UCB units to optimize the cell dose. Two patients received one HLA-mismatched, four patients two HLA-mismatched and three patients three HLA-mismatched grafts. Clinical characteristics of these patients and the infused UCB units are shown in Table 1. There were six male patients and three female patients. Their median weight was 72 kg (range 60–98 kg). Eight patients had AML, two with primary refractory AML, and one patient had advanced refractory CLL. Four patients had hematopoietic cell transplantation comorbidity scores of ⩾2 before transplant.6 All patients received intravenous fludarabine (30 mg/m2/day for 5 days) and intravenous melphalan (100 mg/m2) as the conditioning regimen. The median CD34 cell dose infused was 2.6 × 105/kg (range 1.8 × 105/kg–3.4 × 105/kg), and the median nucleated cell count was 2.3 × 107/kg (range 1.8 × 107/kg–3.8 × 107/kg). GVHD prophylaxis in all patients consisted of oral cyclosporine starting day −2, and methylprednisone starting day +7 at 2 mg/kg/day until day +28 when it was reduced by half every week. The methylprednisone was discontinued on day +56 in the absence of significant GVHD.

Table 1 Patient outcome
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References

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Authors and Affiliations

  1. Biotherapy and Stem Cell Transplant Program, Texas Oncology, Amarillo, TX, USA

    S H Lim, W V Esler, P O Periman, D Beggs, Y Zhang & M Townsend

  2. Oncology Unit, Northwest Texas Hospital Healthcare System, and Harrington Regional Medical Center, Inc., Amarillo, TX, USA

    S H Lim, W V Esler, P O Periman, D Beggs, Y Zhang & M Townsend

Authors
  1. S H Lim
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  2. W V Esler
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  3. P O Periman
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  4. D Beggs
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  5. Y Zhang
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  6. M Townsend
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Correspondence to S H Lim.

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Lim, S., Esler, W., Periman, P. et al. Reduced-intensity umbilical cord blood transplant for older adult patients. Bone Marrow Transplant 42, 685–686 (2008). https://doi.org/10.1038/bmt.2008.225

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