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Blood, 15 October 2001, Vol. 98, No. 8, pp. 2332-2338
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Standardized, unrelated donor cord blood transplantation in
adults with hematologic malignancies
Guillermo F. Sanz,
Silvana Saavedra,
Dolores Planelles,
Leonor Senent,
Jose Cervera,
Eva Barragán,
Carmen Jiménez,
Luis Larrea,
Guillermo Martín,
Jesús Martínez,
Isidro Jarque,
Federico Moscardó,
Gemma Plumé,
Rafael Andreu,
Ana I. Regadera,
Inmaculada García,
Susana Mollá,
Pilar Solves,
Javier de la
Rubia,
Pascual Bolufer,
Luis Benlloch,
María A. Soler,
María L. Marty, and
Miguel A. Sanz
From the Bone Marrow Transplantation Unit, Department
of Hematology, and Laboratory of Molecular Biology, Department of
Clinical Pathology, Hospital Universitario La Fe; and Centro de
Trasfusión de la Comunidad Valenciana; both of Valencia, Spain.
The potential role of unrelated donor cord blood
transplantation (UD-CBT) in adults remains unclear. This study reports
the results of UD-CBT in 22 adults with hematologic malignancies
following conditioning with thiotepa, busulfan, cyclophosphamide, and
antithymocyte globulin in 21, with thiotepa, fludarabine, and
antithymocyte globulin in 1, and graft-versus-host disease (GVHD)
prophylaxis with cyclosporine and prednisone. Median age was 29 years
(range, 18-46 years), and median weight was 69.5 kg (range, 41-85 kg). HLA match was 6 of 6 in 1 case, 5 of 6 in 13 cases, and 4 of 6 in 8 cases. Median number of nucleated cells infused was
1.71 × 107/kg (range, 1.01 × 107/kg to
4.96 × 107/kg). All 20 patients surviving more than 30 days had myeloid engraftment, and only 1, who received the lowest cell
dose, developed secondary graft failure. Median time to reach an
absolute neutrophil count of at least 0.5 × 109/L was 22 days (range, 13-52 days). Median time to platelets numbered at least
20 × 109/L was 69 days (range, 49-153 days). Seven
patients (32%) developed acute GVHD above grade II, and 9 of 10 patients at risk developed chronic GVHD, which became extensive in 4 patients. Twelve patients remained alive and disease-free 3 to 45 months after transplantation. Disease-free survival (DFS) at 1 year was
53%. Age strongly influenced DFS (P = .01). For patients
aged 30 years or younger, the DFS at 1 year was 73%. These preliminary
results suggest that UD-CBT should be considered a reasonable
alternative in young adults with hematologic malignancy and no
appropriate bone marrow donor.
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