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Cord blood index predicts engraftment and early non-relapse mortality in adult patients with single-unit cord blood transplantation

Bone Marrow Transplantation volume 56, pages 2771–2778 (2021)Cite this article

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Abstract

How to select optimal cord blood (CB) remains an important clinical question. We developed and validated an index of CB engraftment, the cord blood index (CBI), which uses three weighted variables representing cell doses and HLA mismatches. We modeled the neutrophil engraftment time with competing events by random survival forests for competing risks as a function of the predictors: total nucleated cells, CD34, colony-forming units for granulocytes/macrophages, and the number of HLA mismatches at the antigen and allele levels. The CBI defined three groups that had different neutrophil engraftment rates at day 30 (High, 83.7% [95% CI, 79.2–88.1%]; Intermediate, 77.0% [95% CI, 73.7–80.2%]; Low, 68.4% [95% CI, 63.6–73.2%]), platelet engraftment rates at day 60 (High, 70.4% [95% CI, 64.9–75.9%]; Intermediate, 62.3% [95% CI, 58.5–66.0%]; Low, 49.3% [95% CI, 44.2–54.5%]), and non-relapse mortality at day 100 (High, 14.1% [95% CI, 9.9–18.3%]; Intermediate, 16.4% [95% CI, 13.5–19.3%]; Low, 21.3% [95% CI, 17.1–25.5%]). This novel approach is clinically beneficial and can be adopted immediately because it uses easily obtained pre-freeze data of CB.

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Fig. 1: Neutrophil engraftment in the three groups defined by the CBI.
Fig. 2: Platelet engraftment in the three groups defined by the CBI.
Fig. 3: Transplant outcomes and cumulative incidences of GVHD in the three groups defined by the CBI.

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Acknowledgements

The authors express their sincere thanks to the mothers who donated cord blood and the collection staff of the Japanese Red Cross Kanto-Koshinetsu Cord Blood Bank. We are also grateful to the staff of the Japanese Red Cross Kanto-Koshinetsu Cord Blood Bank for cord blood banking and aiding in hematopoietic stem cell transplantation.

The Japanese Red Cross Kanto-Koshinetsu Cord Blood Bank

Aiiku Hospital, Aiwa Hospital, Ebina General Hospital, Hayashida Ladies Clinic, Ikeshita Ladies Child Clinic, Ikeshita Ladies Clinic Musashino, Ikeshita Ladies Clinic Shinonome, Isehara Kyodo Hospital, Japanese Red Cross Katsushika Maternity Hospital, Japanese Red Cross Medical Center, Japanese Red Cross Musashino Hospital, Kaneko Ladies Clinic, Kanto Rosai Hospital, KKR Tohoku Kosai Hospital, Saiseikai Yokohama-shi Nanbu Hospital, Sendai Medical Center, Shonan Fujisawa Tokushukai Hospital, Shonan Kugenuma Clinic, Showa University Fujigaoka Hospital, St. Luke’s International Hospital, Tokyo Adventist Hospital, Tokyo Women’s Medical University Yachiyo Medical Center, Yahata Women’s Clinic, Yamaguchi Women’s Hospital, Yokohama City University Medical Center, and Yokohama Minami Kyousai Hospital.

Author information

Authors and Affiliations

  1. Japanese Red Cross Tokyo Metropolitan Blood Center, Tokyo, Japan

    Gaku Kondo, Fumihiko Ishimaru & Noriko Namba

  2. Japanese Red Cross Kanto-Koshinetsu Block Blood Center, Tokyo, Japan

    Fumihiko Ishimaru, Atsuko Ogawa, Mutsuko Minemoto, Koichi Kashiwase, Fumihiro Azuma, Miyuki Ito, Hirokazu Tsuno, Tadashi Nagai, Kazuo Muroi & Kazunori Nakajima

  3. The Institute of Medical Science, The University of Tokyo, Tokyo, Japan

    Takaaki Konuma & Satoshi Takahashi

  4. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yoshiko Atsuta

  5. Showa University Fujigaoka Hospital, Kanagawa, Japan

    Keiichi Isoyama

  6. Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

    Takeshi Kobayashi & Kazuteru Ohashi

  7. Japanese Red Cross Central Blood Institute, Tokyo, Japan

    Fumiaki Nakajima

  8. Hiruma Clinic, Tokyo, Japan

    Kiyoshi Hiruma

  9. Toranomon Hospital, Tokyo, Japan

    Shigeyoshi Makino

  10. Kawagoe Preventive Medical Center Clinic, Saitama, Japan

    Hideo Mugishima

  11. Japanese Red Cross Kanto-Koshinetsu Cord Blood Bank, Tokyo, Japan

    G. Kondo, F. Ishimaru, A. Ogawa, M. Minemoto, K. Kashiwase, F. Azuma, M. Ito, N. Namba, H. Tsuno, T. Nagai, K. Muroi & K. Nakajima

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  1. Gaku Kondo
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on behalf of the Japanese Red Cross Kanto-Koshinetsu Cord Blood Bank

  • G. Kondo
  • , F. Ishimaru
  • , A. Ogawa
  • , M. Minemoto
  • , K. Kashiwase
  • , F. Azuma
  • , M. Ito
  • , N. Namba
  • , H. Tsuno
  • , T. Nagai
  • , K. Muroi
  •  & K. Nakajima

Contributions

GK, FI, T Konuma, and ST were responsible for data analysis and interpretation, and wrote the manuscript. YA, AO, MM, KK, FA, and MI were responsible for the collection and assembly of data. KI, T Kobayashi, KO, FN, KH, SM, HM, NN, HT, and TN were responsible for the conception and design. KM and KN provided financial and administrative support. All authors provided final approval of the manuscript.

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Correspondence to Fumihiko Ishimaru.

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Kondo, G., Ishimaru, F., Konuma, T. et al. Cord blood index predicts engraftment and early non-relapse mortality in adult patients with single-unit cord blood transplantation. Bone Marrow Transplant 56, 2771–2778 (2021). https://doi.org/10.1038/s41409-021-01406-7

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