|
|
Prepublished online as a Blood First Edition Paper on June 7, 2002; DOI 10.1182/blood-2002-01-0294.
Previous Article | Table of Contents | Next Article 
Blood, 1 September 2002, Vol. 100, No. 5, pp. 1611-1618
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Transplantation of unrelated donor umbilical cord blood in 102 patients with malignant and nonmalignant diseases: influence of CD34
cell dose and HLA disparity on treatment-related mortality and
survival
John E. Wagner,
Juliet N. Barker,
Todd E. DeFor,
K. Scott Baker,
Bruce R. Blazar,
Cindy Eide,
Anne Goldman,
John Kersey,
William Krivit,
Margaret L. MacMillan,
Paul J. Orchard,
Charles Peters,
Daniel J. Weisdorf,
Norma K. C. Ramsay, and
Stella M. Davies
From the Blood and Marrow Transplant Program of the
Departments of Pediatrics and Medicine and the Biostatistical Support
Group, University of Minnesota Cancer Center and School of Medicine,
Minneapolis.
The potential benefits of unrelated donor marrow
transplantation are offset by the immunologic complications of
graft-versus-host disease (GVHD) and infection. Therefore, we used
cryopreserved umbilical cord blood (UCB) as a strategy to reduce the
risks of GVHD and treatment-related mortality (TRM) and improve
survival. Data on 102 patients (median age 7.4 years) who received
transplants between 1994 and 2001 for the treatment of malignant
(n = 65; 68% were high-risk patients) and nonmalignant (n = 37) diseases were evaluated. Log-rank tests and Cox regression analyses
were used to determine the effects of various demographic,
graft-related, and treatment factors on engraftment, GVHD, TRM,
relapse, and survival. As of October 15, 2001, the median follow-up was
2.7 years (range, 0.3-7.2). Incidences of neutrophil and platelet engraftment were 0.88 (CI, 0.81-0.95) and 0.65 (CI, 0.53-0.77), respectively. Notably, incidences of severe acute and chronic GVHD were
0.11 (CI, 0.05-0.17) and 0.10 (CI, 0.04-0.16), respectively. At 1 year
after transplantation, proportions of TRM and survival were 0.30 (CI,
0.21-0.39) and 0.58 (CI, 0.48-0.68), respectively. In Cox regression
analyses, CD34 cell dose was the one factor consistently identified as
significantly associated with rate of engraftment, TRM, and survival.
Despite the low incidence of GVHD, the proportion of patients with
leukemia relapse at 2 years was 0.17 (CI, 0.00-0.38) and 0.45 (CI,
0.28-0.61) for patients with standard and high-risk disease,
respectively. There is a high probability of survival in recipients of
UCB grafts that are disparate in no more than 2 human leukocyte
antigens (HLAs) when the grafts contain at least
1.7 × 105 CD34+ cells per kilogram of
recipient's body weight. Therefore, graft selection should be based
principally on CD34 cell dose when multiple UCB units exist with an HLA
disparity of 2 or less.

CiteULike Connotea Del.icio.us Digg Reddit Technorati What's this?
This article has been cited by other articles:

|
 |

|
 |
 
C. G. Brunstein, J. N. Barker, D. J. Weisdorf, T. E. DeFor, J. S. Miller, B. R. Blazar, P. B. McGlave, and J. E. Wagner
Umbilical cord blood transplantation after nonmyeloablative conditioning: impact on transplantation outcomes in 110 adults with hematologic disease
Blood,
October 15, 2007;
110(8):
3064 - 3070.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. P. Iori, W. Arcese, F. Milano, E. Calabrese, G. F. Torelli, W. Barberi, M. G. Mascolo, L. De Felice, M. Screnci, B. Lucarelli, et al.
Unrelated cord blood transplant in children with high-risk acute lymphoblastic leukemia: a long-term follow-up
Haematologica,
August 1, 2007;
92(8):
1051 - 1058.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. Smythe, S. Armitage, D. McDonald, D. Pamphilon, M. Guttridge, J. Brown, A. Green, C. Brown, R. M. Warwick, A. Lankester, et al.
Directed Sibling Cord Blood Banking for Transplantation: The 10-Year Experience in the National Blood Service in England
Stem Cells,
August 1, 2007;
25(8):
2087 - 2093.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Yang, K. Li, P. C. Ng, C. K. Y. Chuen, T. K. Lau, Y. S. Cheng, Y. S. Liu, C. K. Li, P. Man Pan Yuen, A. Edward James, et al.
Promoting Effects of Serotonin on Hematopoiesis: Ex Vivo Expansion of Cord Blood CD34+ Stem/Progenitor Cells, Proliferation of Bone Marrow Stromal Cells, and Antiapoptosis
Stem Cells,
July 1, 2007;
25(7):
1800 - 1806.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. N. Barker
Umbilical Cord Blood (UCB) Transplantation: An Alternative to the Use of Unrelated Volunteer Donors?
Hematology,
January 1, 2007;
2007(1):
55 - 61.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
K. Vanheusden, S. Van Coppernolle, M. De Smedt, J. Plum, and B. Vandekerckhove
In Vitro Expanded Cells Contributing to Rapid Severe Combined Immunodeficient Repopulation Activity Are CD34+38-33+90+45RA-
Stem Cells,
January 1, 2007;
25(1):
107 - 114.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. Terakura, E. Azuma, M. Murata, T. Kumamoto, M. Hirayama, M. Yazaki, T. Naoe, and K. Kato
Engraftment Rate and Kinetics Following Umbilical Cord Blood Transplantation Is Critically Affected by CD34+ Progenitor Cell Dose and CD8+ T-Cell Dose Complementary.
Blood (ASH Annual Meeting Abstracts),
November 16, 2006;
108(11):
5396 - 5396.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
K. M. Pastos, W. B. Slayton, L. M. Rimsza, L. Young, and M. C. Sola-Visner
Differential effects of recombinant thrombopoietin and bone marrow stromal-conditioned media on neonatal versus adult megakaryocytes
Blood,
November 15, 2006;
108(10):
3360 - 3362.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. M. Calvi
Hematopoietic-Osteoblastic Interactions in the Hematopoietic Stem Cell Niche
IBMS BoneKEy,
May 1, 2006;
3(5):
10 - 18.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. S. Majhail, D. J. Weisdorf, J. E. Wagner, T. E. Defor, C. G. Brunstein, and L. J. Burns
Comparable results of umbilical cord blood and HLA-matched sibling donor hematopoietic stem cell transplantation after reduced-intensity preparative regimen for advanced Hodgkin lymphoma
Blood,
May 1, 2006;
107(9):
3804 - 3807.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
E. A. Copelan
Hematopoietic stem-cell transplantation.
N. Engl. J. Med.,
April 27, 2006;
354(17):
1813 - 1826.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
K. Li, C. K. Y. Chuen, S. M. Lee, P. Law, T. F. Fok, P. C. Ng, C. K. Li, D. Wong, A. Merzouk, H. Salari, et al.
Small Peptide Analogue of SDF-1{alpha} Supports Survival of Cord Blood CD34+ Cells in Synergy with Other Cytokines and Enhances Their Ex Vivo Expansion and Engraftment into Nonobese Diabetic/Severe Combined Immunodeficient Mice
Stem Cells,
January 1, 2006;
24(1):
55 - 64.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. J. Fraser, B. A. Hirsch, V. Dayton, M. H. Creer, J. P. Neglia, J. E. Wagner, and K. S. Baker
First report of donor cell-derived acute leukemia as a complication of umbilical cord blood transplantation
Blood,
December 15, 2005;
106(13):
4377 - 4380.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
W. B. Slayton, D. A. Wainman, X. M. Li, Z. Hu, A. Jotwani, C. R. Cogle, D. Walker, R. C. Fisher, J. R. Wingard, E. W. Scott, et al.
Developmental Differences in Megakaryocyte Maturation Are Determined by the Microenvironment
Stem Cells,
September 1, 2005;
23(9):
1400 - 1408.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. J. Lee
New approaches for preventing and treating chronic graft-versus-host disease
Blood,
June 1, 2005;
105(11):
4200 - 4206.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
K. K. Ballen
New trends in umbilical cord blood transplantation
Blood,
May 15, 2005;
105(10):
3786 - 3792.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. Bornstein, A. I. Flores, M. A. Montalban, M. J. del Rey, J. de la Serna, and F. Gilsanz
A Modified Cord Blood Collection Method Achieves Sufficient Cell Levels for Transplantation in Most Adult Patients
Stem Cells,
March 1, 2005;
23(3):
324 - 334.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. De Felice, C. Tatarelli, M. G. Mascolo, C. Gregorj, F. Agostini, R. Fiorini, V. Gelmetti, S. Pascale, F. Padula, M. T. Petrucci, et al.
Histone Deacetylase Inhibitor Valproic Acid Enhances the Cytokine-Induced Expansion of Human Hematopoietic Stem Cells
Cancer Res.,
February 15, 2005;
65(4):
1505 - 1513.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. N. Barker, D. J. Weisdorf, T. E. DeFor, B. R. Blazar, P. B. McGlave, J. S. Miller, C. M. Verfaillie, and J. E. Wagner
Transplantation of 2 partially HLA-matched umbilical cord blood units to enhance engraftment in adults with hematologic malignancy
Blood,
February 1, 2005;
105(3):
1343 - 1347.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
W. Tse and M. J. Laughlin
Umbilical Cord Blood Transplantation: A New Alternative Option
Hematology,
January 1, 2005;
2005(1):
377 - 383.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. Takahashi, T. Iseki, J. Ooi, A. Tomonari, K. Takasugi, Y. Shimohakamada, T. Yamada, K. Uchimaru, A. Tojo, N. Shirafuji, et al.
Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies
Blood,
December 1, 2004;
104(12):
3813 - 3820.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
V. Rocha, M. Labopin, G. Sanz, W. Arcese, R. Schwerdtfeger, A. Bosi, N. Jacobsen, T. Ruutu, M. de Lima, J. Finke, et al.
Transplants of Umbilical-Cord Blood or Bone Marrow from Unrelated Donors in Adults with Acute Leukemia
N. Engl. J. Med.,
November 25, 2004;
351(22):
2276 - 2285.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
B. Vandekerckhove, I. Van haute, N. Lootens, C. De Buck, L. Verdegem, V. Van De Steene, S. De Smet, and D. Craeye
Selection of Cord Blood Units Based on CD34+ Cells for Storage in Cord Blood Bank.
Blood (ASH Annual Meeting Abstracts),
November 16, 2004;
104(11):
4999 - 4999.
[Abstract]
|
 |
|

|
 |

|
 |
 
S. Miyakoshi, K. Yuji, M. Kami, E. Kusumi, Y. Kishi, K. Kobayashi, N. Murashige, T. Hamaki, S.-W. Kim, J.-i. Ueyama, et al.
Successful Engraftment After Reduced-Intensity Umbilical Cord Blood Transplantation for Adult Patients with Advanced Hematological Diseases
Clin. Cancer Res.,
June 1, 2004;
10(11):
3586 - 3592.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. J. Chao, S. G. Emerson, and K. I. Weinberg
Stem Cell Transplantation (Cord Blood Transplants)
Hematology,
January 1, 2004;
2004(1):
354 - 371.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
G. Michel, V. Rocha, S. Chevret, W. Arcese, K.-W. Chan, A. Filipovich, T. A. Takahashi, M. Vowels, J. Ortega, P. Bordigoni, et al.
Unrelated cord blood transplantation for childhood acute myeloid leukemia: a Eurocord Group analysis
Blood,
December 15, 2003;
102(13):
4290 - 4297.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. N. Barker, D. J. Weisdorf, T. E. DeFor, B. R. Blazar, J. S. Miller, and J. E. Wagner
Rapid and complete donor chimerism in adult recipients of unrelated donor umbilical cord blood transplantation after reduced-intensity conditioning
Blood,
September 1, 2003;
102(5):
1915 - 1919.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. S. Grewal, J. N. Barker, S. M. Davies, and J. E. Wagner
Unrelated donor hematopoietic cell transplantation: marrow or umbilical cord blood?
Blood,
June 1, 2003;
101(11):
4233 - 4244.
[Full Text]
[PDF]
|
 |
|
| |