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Cord Blood Stem Cells

Prospective study of one- vs two-unit umbilical cord blood transplantation following reduced intensity conditioning in adults with hematological malignancies

Bone Marrow Transplantation volume 47, pages 924–933 (2012)Cite this article

Abstract

As the threshold nucleated cell dose for one-unit umbilical cord blood (UCB) in adults has not to date been firmly established, we prospectively compared one- vs two-unit UCB transplantation after reduced intensity conditioning (RIC) in adult patients with hematological malignancies. Study design specified one-UCB unit if the cryopreserved total nucleated cell (TNC) dose was ⩾2.5 × 107/kg recipient weight, otherwise two units matched at minima of 4/6 HLA loci to the patient and 3/6 to each other were infused. A total of 27 patients received one unit; 23 patients received two units. Median time to ANC >500/μL was 24 days (95% confidence interval 22–28 days), 25 days for one unit and 23 days for two units (P=0.99). At day 100, ANC >500/μL was 88.4 and 91.3% in the one- and two-unit groups (P=0.99), respectively. Three-year EFS was 28.6% and 39.1% in the one- and two-unit groups (P=0.71), respectively. Infusion of two units was associated with a significantly lower relapse risk, 30.4% vs 59.3% (P=0.045). Infused cell doses (TNC, CD3+, CD34+ and CD56+CD3neg) did not impact on engraftment, OS or EFS. Taken together, one-unit UCB transplantation with a threshold cell dose ⩾2.5 × 107/kg recipient weight after RIC is a viable option for adults, although infusion of two units confers a lower relapse incidence.

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Acknowledgements

We like to thank all members of the Seidman Cancer Center for their excellence in patient care. This work was supported by: RO1-AI47289–01 (MJL), the Stem Cell Facility of the Case Comprehensive Cancer Center 5P30CA043703 (ClinicalTrials.gov identifier: NCT00003335), the Abraham J and Phyllis Katz Foundation (MJL), and the Dr Donald and Ruth Weber Goodman Philanthropic Fund (MJL).

Author contributions: Research design: MJL. Patient care: TK-K, YH, WvH, HML, BWC, SLG, PB, WWT, RJC, MJL. Laboratory analysis: HJM, CC, LRF, MJL. Data collection: TK-K, YH, CC, LRF, MJL. Statistical analysis: SM, PF. Manuscript preparation: TK-K, YH, MJL, LRF, HML. Manuscript review: All authors.

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Authors and Affiliations

  1. Department of Medicine, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA

    T L Kindwall-Keller, W van Heeckeren, H M Lazarus, B W Cooper, S L Gerson, L R Fanning, R J Creger, J M Carlson-Barko & M J Laughlin

  2. Department of Bone Marrow Transplantation, University Hospital of Essen, Essen, Germany

    Y Hegerfeldt

  3. Department of Pathology, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA

    H J Meyerson

  4. Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA

    S Margevicius & P Fu

  5. Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA

    P Barr

  6. Department of Medicine, West Virginia University Health Science Center, Morgantown, WV, USA

    W W Tse

  7. Department of Genetics, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    C Curtis

  8. Department of Medicine, Division of Hematology/Oncology, University of Virginia School of Medicine, Charlottesville, VA, USA

    T L Kindwall-Keller & M J Laughlin

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Correspondence to M J Laughlin.

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Kindwall-Keller, T., Hegerfeldt, Y., Meyerson, H. et al. Prospective study of one- vs two-unit umbilical cord blood transplantation following reduced intensity conditioning in adults with hematological malignancies. Bone Marrow Transplant 47, 924–933 (2012). https://doi.org/10.1038/bmt.2011.195

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