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Blood, 15 October 2007, Vol. 110, No. 8, pp. 3064-3070.
Prepublished online as a Blood First Edition Paper on June 14, 2007; DOI 10.1182/blood-2007-04-067215.
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TRANSPLANTATION
Umbilical cord blood transplantation after nonmyeloablative conditioning: impact on transplantation outcomes in 110 adults with hematologic disease
Claudio G. Brunstein1,2,
Juliet N. Barker1,2,
Daniel J. Weisdorf1,2,
Todd E. DeFor1,3,
Jeffrey S. Miller1,2,
Bruce R. Blazar1,3,
Philip B. McGlave1,2, and
John E. Wagner1,3
1 Blood and Marrow Transplant Program and
Divisions of 2 Medical Hematology, Oncology, and Transplantation and
3 Pediatric Hematology and Oncology, University of Minnesota, Minneapolis
We evaluated the efficacy of umbilical cord blood (UCB) in the setting of a nonmyeloablative regimen consisting of fludarabine (200 mg/m2), cyclophosphamide (50 mg/kg), and a single fraction of total body irradiation (200 cGy) with cyclosporine and mycophenolate mofetil for posttransplantation immunoprophylaxis. The target cell dose for the UCB graft was 3.0 x 107 nucleated cells/kg, resulting in the selection of a second partially human leukocyte antigen-matched UCB unit in 85%. One hundred ten patients with hematologic disease were enrolled. Neutrophil recovery was achieved in 92% at a median of 12 days. Incidences of grades III and IV acute and chronic graft-versus-host disease (GVHD) were 22% and 23%, respectively. Transplantation-related mortality was 26% at 3 years. Survival and event-free survival (EFS) at 3 years were 45% and 38%, respectively. Favorable risk factors for survival were absence of high-risk clinical features (Karnofsky 50-60, serious organ dysfunction, recent fungal infection, P < .01) and absence of severe GVHD (P = .04), and favorable risk factors for EFS were absence of high-risk clinical features (P < .01) and use of 2 UCB units (P = .07). These findings support the use of UCB after a nonmyeloablative conditioning as a strategy for extending the availability of transplantation therapy, particularly for older patients.
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