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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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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DOI: https://doi.org/10.1038/bmt.2011.195
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