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Graft Source

A prospective investigation of cell dose in single-unit umbilical cord blood transplantation for adults with high-risk hematologic malignancies

Bone Marrow Transplantation volume 50, pages 1519–1525 (2015)Cite this article

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Abstract

Umbilical cord blood (UCB) as an allogeneic transplant source is generally limited to units with pre-cryopreservation total nucleated cell (TNC) doses ⩾2.5 × 107 NC/kg. We prospectively investigated single UCB transplantation, with cord units as low as 1 × 107 NC/kg, all processed with post-thaw albumin–dextran dilution. We transplanted 104 adult patients with 84% having relapsed/refractory disease. The median TNC dose was 2.1 × 107 NC/kg (range: 1.0–4.4 × 107) and median CD34+ cell dose was 1.0 × 105/kg (range: 0.0–3.7 × 105/kg). Post-manipulation cell recovery and viability were 96% and 99%, respectively. Median times to neutrophil and platelet engraftment were 16 and 43 days, respectively. Univariate factors predicting neutrophil engraftment included TNC (P=0.03) and CD34+ cell dose (P=0.01). CD34+ dose predicted platelet engraftment (P<0.001). In multivariate analysis, CD34+ dose remained significant for neutrophil and platelet engraftment (P<0.0001 and P<0.0001, respectively). The 100-day and 1-year overall survival were 70% and 46%, respectively (95% confidence interval: 36%–56% at 1 year). The subset transplanted with 1–1.5 × 107 NC/kg had similar 100-day and 1-year survivals of 73% and 45%, respectively. Single-unit UCB transplantation using small units, processed as described, leads to favorable engraftment and acceptable outcomes in poor prognosis patients. CD34+ cell dose (⩾1.5 × 105/kg) helps predict faster engraftment and can aid in graft selection.

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Acknowledgements

We thank our transplant center’s nursing staff, advance practice nurses, research assistants, social workers and case managers for their invaluable ongoing contributions to patient care.

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  1. Loyola University Medical Center, Cardinal Bernardin Cancer Center, Maywood, IL, USA

    U Sobol, A Go, S Kliethermes, S Bufalino, T Rodriguez, S Smith, M Parthasarathy & P Stiff

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Correspondence to P Stiff.

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Sobol, U., Go, A., Kliethermes, S. et al. A prospective investigation of cell dose in single-unit umbilical cord blood transplantation for adults with high-risk hematologic malignancies. Bone Marrow Transplant 50, 1519–1525 (2015). https://doi.org/10.1038/bmt.2015.194

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