Reduced-intensity conditioning (RIC) regimens in cord blood transplant (CBT) are increasingly utilized for older patients and those with comorbidities. However, the optimal conditioning regimen has not yet been established and remains a significant challenge of this therapeutic approach. Antithymocyte globulin (ATG) has been incorporated into conditioning regimens in order to decrease the risk of graft failure; however, use of ATG is often associated with infusion reactions and risk of post-transplant complications. We report the results of a non-ATG-containing RIC regimen, where patients received 2 Gy TBI unless they were considered to be at higher risk of graft failure, in which case they received 3 Gy of TBI. Thirty patients underwent CBT using this protocol for high-risk hematological malignancies. There was only one case of secondary and no cases of primary graft failure. At 1 year, estimates of non-relapse mortality, OS and PFS were 29%, 53% and 45%, respectively. The cumulative incidences of grade III–IV acute and chronic GVHD were 14% and 18%, respectively. In summary, the results of this study demonstrate that this non-ATG-containing conditioning regimen provides a low incidence of graft failure without increasing regimen-related toxicity.
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We are grateful to the patients and families who consented to the use of clinical research results and biologic specimens in these trials. We thank Denise Ziegler, Ivy Riffkin, MaryJoy Lopez and Adrienne Papermaster for their assistance in the preparation of this manuscript. This work was supported by the National Institutes of Health (grants K23 HL077446, CD; ALC CA18029 and CA 78902). CD is a Damon Runyon Clinical Investigator supported in part by the Damon Runyon Cancer Research Foundation (CI# 35-07). FM is a recipient of a Research Fellowship from the Fondazione Internazionale di Ricerca in Medicina Sperimentale, Torino, Italy sponsored by ‘Provincia di Benevento’.
Author Contributions: FO, FM and CD participated in the study design, data analysis and interpretation of data for the manuscript. FO wrote the first draft and FM, TAG, JG, PM, PF, BS, RS and CD provided revisions and critical review of the final manuscript. TAG and FM performed the statistical analyses.
The authors declare no conflicts of interest.
Presented in part at the 53rd Annual American Society of Hematology Conference in San Diego, CA, 10–13, December, 2011.
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Ostronoff, F., Milano, F., Gooley, T. et al. Double umbilical cord blood transplantation in patients with hematologic malignancies using a reduced-intensity preparative regimen without antithymocyte globulin. Bone Marrow Transplant 48, 782–786 (2013). https://doi.org/10.1038/bmt.2012.243
- umbilical cord blood transplant
- reduced-intensity conditioning regimen
- antithymocyte globuline
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