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Unrelated cord blood transplantation for severe aplastic anemia using intensified immunoablative conditioning regimen leading to high engraftment and survival

Bone Marrow Transplantation volume 55, pages 1677–1680 (2020)Cite this article

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Unrelated cord blood transplantation (UCBT) has become a widely accepted treatment for hematological malignancies, but it has less been used in cases of severe aplastic anemia (SAA) [1]. High-graft failure (GF) rates have been observed in early retrospective studies [2, 3]. Recently, several studies reported improvements in engraftment and overall survival (OS) using conditioning regimens containing low-dose total-body irradiation (TBI) [4,5,6,7,8]. To overcome graft rejection, we investigated the outcomes of patients who underwent UCBT for SAA using a new TBI-free intensified immunoablative regimen based on the standard conditioning regimen of cyclophosphamide (CY) 200 mg/kg [9].

Fifteen consecutive acquired SAA patients who underwent UCBT between October 2013 and November 2018 were analyzed in this retrospective study. Data collected as of 28 February 2019. This study was approved by the Ethics Committee of our institute. No patients had a response to previous therapy; nine patients had received immunosuppressive treatment (IST), including cyclosporin A (CsA) and rabbit antithymocyte globulin (ATG), prior to UCBT, whereas the other six patients were treated with CsA only for economic reasons.

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References

  1. Niederwieser D, Baldomero H, Szer J, Gratwohl M, Aljurf M, Atsuta Y, et al. Hematopoietic stem cell transplantation activity worldwide in 2012 and a SWOT analysis of the Worldwide Network for blood and marrow transplantation group including the global survey. Bone Marrow Transpl. 2016;51:778–85.

    Article  CAS  Google Scholar 

  2. Yoshimi A, Kojima S, Taniguchi S, Hara J, Matsui T, Takahashi Y, et al. Unrelated cord blood transplantation for severe aplastic anemia. Biol Blood Marrow Transplant. 2008;14:1057–63.

    Article  CAS  Google Scholar 

  3. Peffault de Latour R, Purtill D, Ruggeri A, Sanz G, Michel G, Gandemer V, et al. Influence of nucleated cell dose on overall survival of unrelated cord blood transplantation for patients with severe acquired aplastic anemia: a study by eurocord and the aplastic anemia working party of the European group for blood and marrow transplantation. Biol Blood Marrow Transplant. 2011;17:78–85.

    Article  Google Scholar 

  4. Yamamoto H, Kato D, Uchida N, Ishiwata K, Araoka H, Takagi S, et al. Successful sustained engraftment after reduced-intensity umbilical cord blood transplantation for adult patients with severe aplastic anemia. Blood 2011;117:3240–2.

    Article  CAS  Google Scholar 

  5. Peffault de Latour R, Chevret S, Jubert C, Sirvent A, Galambrun C, Ruggeri A, et al. Unrelated cord blood transplantation in patients with acquired refractory aplastic anemia: a nationwide phase II study. Blood 2018;132:750–4.

    Article  CAS  Google Scholar 

  6. Ochi T, Onishi Y, Nasu K, Onodera K, Kobayashi M, Ichikawa S, et al. Umbilical cord blood transplantation using reduced-intensity conditioning without antithymocyte globulin in adult patients with severe aplastic anemia. Biol Blood Marrow Transplant. 2019;25:e55–e59.

    PubMed  Google Scholar 

  7. Kuwatsuka Y, Kanda J, Yamazaki H, Mori T, Miyamura K, Kako S, et al. A comparison of outcomes for cord blood transplantation and unrelated bone marrow transplantation in adult aplastic anemia. Biol Blood Marrow Transplant. 2016;22:1836–43.

    PubMed  Google Scholar 

  8. Kudo K, Muramatsu H, Narita A, Yoshida N, Kobayashi R, Yabe H, et al. Unrelated cord blood transplantation in aplastic anemia:is anti-thymocyte globulin indispensable for conditioning? Bone Marrow Transpl. 2017;52:1659–61.

    Article  CAS  Google Scholar 

  9. Storb R, Leisenring W, Anasetti C, Appelbaum FR, Buckner CD, Bensinger WI, et al. Long-term follow-up of allogeneic marrow transplants in patients with aplastic anemia conditioned by cyclophosphamide combined with antithymocyte globulin. Blood. 1997;89:3890–1.

    Article  CAS  Google Scholar 

  10. Chan KW, McDonald L, Lim D, Grimley MS, Grayson G, Wall DA. Unrelated cord blood transplantation in children with idiopathic severe aplastic anemia. Bone Marrow Transpl. 2008;42:589–95.

    Article  CAS  Google Scholar 

  11. Tolar J, Deeg HJ, Arai S, Horwitz M, Antin JH, McCarty JM, et al. Fludarabine-based conditioning for marrow transplantation from unrelated donors in severe aplastic anemia: early results of a cyclophosphamide dose deescalation study show life-threatening adverse events at predefined cyclophosphamide dose levels. Biol Blood Marrow Transplant. 2012;18:1007–11.

    Article  CAS  Google Scholar 

  12. Xu LP, Wang SQ, Wu DP, Wang JM, Gao SJ, Jiang M, et al. Haplo-identical transplantation for acquired severe aplastic anaemia in a multicentre prospective study. Br J Haematol. 2016;175:265–74.

    Article  Google Scholar 

  13. Bacigalupo A, Socie’ G, Lanino E, Prete A, Locatelli F, Locasciulli A, et al. Fludarabine, cyclophosphamide, antithymocyte globulin, with or without low dose total body irradiation, for alternative donor transplants, in acquired severe aplastic anemia: a retrospective study from the EBMT-SAA Working Party. Haematologica. 2010;95(Jun):976–82.

    Article  CAS  Google Scholar 

  14. Pascal L, Mohty M, Ruggeri A, Tucunduva L, Milpied N, Chevallier P, et al. Impact of rabbit ATG-containing myeloablative conditioning regimens on the outcome of patients undergoing unrelated single-unit cord blood transplantation for hematological malignancies. Bone Marrow Transpl. 2015;50:45–50.

    Article  CAS  Google Scholar 

  15. Admiraal R, van Kesteren C, Jol-van der Zijde CM, Lankester AC, Bierings MB, Egberts TC, et al. Association between anti-thymocyte globulin exposure and CD4+ immune reconstitution in paediatric haemopoietic cell transplantation: a multicentre, retrospective pharmacodynamic cohort analysis. Lancet Haematol. 2015;2:e194–203.

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank all the patients and their families for participating in this study. The authors would like to thank the physicians, nurses, and support personnel for their care of patients in this study.

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  1. These authors contributed equally: Shengnan Du, Wenduo He

Authors and Affiliations

  1. Medical School of Southeast University, Nanjing, China

    Shengnan Du, Yilian Yang, Xingchen Gao & Jiahua Ding

  2. Department of Hematology, ZhongDa Hospital Southeast University, Nanjing, China

    Wenduo He & Jiahua Ding

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  1. Shengnan Du
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Correspondence to Jiahua Ding.

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Du, S., He, W., Yang, Y. et al. Unrelated cord blood transplantation for severe aplastic anemia using intensified immunoablative conditioning regimen leading to high engraftment and survival. Bone Marrow Transplant 55, 1677–1680 (2020). https://doi.org/10.1038/s41409-019-0736-5

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