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Reduced-Intensity Conditioning Followed by Unrelated Umbilical Cord Blood Transplantation for Advanced Hematologic Malignancies: Rapid Engraftment in Bone Marrow

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Abstract

Reduced-intensity (RI) conditioning followed by cord blood transplantation (CBT) is a new treatment modality, but failure to engraft is a major concern. We describe 12 patients with advanced hematologic malignancies who underwent RI conditioning and CBT with a conditioning regimen consisting of 200 mg/m2 fludarabine (Flu), 50 mg/kg cyclophosphamide (CY), and 3 Gy total body irradiation (TBI). Cyclosporin A and/or methotrexate were used for graft-versus-host disease prophylaxis. Cord blood grafts were not mismatched for more than 2 serologically defined HLA alleles but were later found by high-resolution DNA typing to be mismatched for 2 to 4 alleles in most cases. Short tandem repeat analysis of bone marrow cells at day 14 showed complete donor chimerism in 6 of the patients and mixed chimerism in 5, indicating rapid engraftment in the bone marrow, whereas the remaining patient experienced graft rejection. Neutrophil recovery was achieved at a median of day 17 (range, days 11-24) in 10 of the 11 patients with marrow chimerism at day 14. Of these 10 patients, however, transplantation-related mortality within 100 days occurred in 4 patients who showed failed platelet recovery and a lack of durable engraftment. Overall survival and disease-free survival rates were 41.7% and 33.3%, respectively.These results show that CB mismatched at 2 to 4 HLA alleles and transplanted with the Flu/CY/3 Gy TBI regimen is able to engraft in the bone marrow as early as day 14.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Japan

    Mahito Misawa, Masaya Okada, Toshiyuki Nakajima, Kaori Nomura, Takeshi Wakae, Akinari Toda, Hisayuki Itoi, Hiroyuki Takatsuka, Takeyoshi Itsukuma, Keisuke Nishioka & Hiroyasu Ogawa

  2. Division of Blood Transfusion, Japan

    Shunro Kai

  3. Laboratory of Cell Transplantation, Institute for Advanced Medical Sciences, Hyogo College of Medicine, 1-1 Mukogawa-cho, 663-8501, Nishinomiya, Hyogo, Japan

    Yoshihiro Fujimori

  4. Uegahara Hospital, Nishinomiya, Japan

    Hiroshi Hara

Authors
  1. Mahito Misawa
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  2. Masaya Okada
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  3. Toshiyuki Nakajima
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  4. Kaori Nomura
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  5. Takeshi Wakae
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  6. Akinari Toda
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  7. Hisayuki Itoi
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  11. Hiroyasu Ogawa
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  12. Shunro Kai
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  13. Yoshihiro Fujimori
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  14. Hiroshi Hara
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Correspondence to Yoshihiro Fujimori.

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Misawa, M., Okada, M., Nakajima, T. et al. Reduced-Intensity Conditioning Followed by Unrelated Umbilical Cord Blood Transplantation for Advanced Hematologic Malignancies: Rapid Engraftment in Bone Marrow. Int J Hematol 83, 74–79 (2006). https://doi.org/10.1532/IJH97.05124

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  • DOI: https://doi.org/10.1532/IJH97.05124

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