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

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Authors: Sobol, U.; Go, A.; Kliethermes, S; Bufalino, S; Rodriguez, T; Smith, S; Parthasarathy, M.; Stiff, P
Article Title: A prospective investigation of cell dose in single-unit umbilical cord blood transplantation for adults with high-risk hematologic malignancies
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 x 107 NC/kg. We prospectively investigated single UCB transplantation, with cord units as low as 1 x 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 x 107 NC/kg (range: 1.0-4.4 x 107) and median CD34+ cell dose was 1.0 x 105/kg (range: 0.0-3.7 x 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 (P0.001). In multivariate analysis, CD34+ dose remained significant for neutrophil and platelet engraftment (P0.0001 and P0.0001, 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 x 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 x 105/kg) helps predict faster engraftment and can aid in graft selection.Bone Marrow Transplantation advance online publication, 14 September 2015; doi:10.1038/bmt.2015.194.
Journal Title: Bone marrow transplantation
ISSN: 1476-5365; 0268-3369
Publisher: Unknown  
Date Published: 2015
Language: ENG
DOI/URL:

10.1038/bmt.2015.194
Notes: LR: 20150915; JID: 8702459; 2015/02/23 [received]; 2015/06/03 [revised]; 2015/06/19 [accepted]; aheadofprint