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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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.
The authors declare no conflict of interest.
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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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