Single-unit umbilical cord blood transplantation from unrelated donors in patients with hematological malignancy using busulfan, thiotepa, fludarabine and ATG as myeloablative conditioning regimen
Adult
Male
Adolescent
Disease-Free Survival
03 medical and health sciences
0302 clinical medicine
Humans
Child
Busulfan
Antilymphocyte Serum
Neoplasm Staging
Retrospective Studies
Graft Survival
Infant
Recovery of Function
Middle Aged
Myeloablative Agonists
3. Good health
Child, Preschool
Hematologic Neoplasms
myeloablative conditioning regimen
umbilical cord blood
Female
Cord Blood Stem Cell Transplantation
Immunosuppressive Agents
transplantation
DOI:
10.1038/bmt.2012.13
Publication Date:
2012-02-13T12:27:19Z
AUTHORS (13)
ABSTRACT
Attempts to optimize outcomes in cord blood transplantation (CBT) by using new conditioning regimens and standardization of cord blood unit selection are warranted. In all, 88 patients (18 children and 70 adults) with hematological malignancy from nine Spanish institutions underwent a single-unit CBT after an i.v. BU-based myeloablative conditioning regimen. All evaluable patients except one engrafted. The overall cumulative incidence (CI) of myeloid engraftment was 94% at a median time of 19 days. In multivariate analysis, nonadvanced disease stage was the only factor with a favorable impact on myeloid engraftment. The CI of acute GVHD grades II-IV and chronic extensive GVHD were 24% each. The CI of nonrelapse mortality at 100 days, 180 days and 5 years was 14, 23 and 44%, respectively. The 5-year CI of relapse was 18%, whereas disease-free survival (DFS) was 46%, 39% and 11% for patients transplanted in early, intermediate and advanced stages of the disease, respectively. Our study shows high rates of engraftment with fast neutrophil recovery in patients undergoing single-unit CBT using a BU-based conditioning regimen. Long-term DFS can be achieved in a substantial number of patients with high-risk hematological malignancies, particularly when transplanted in an early stage of the disease.
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