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| Rapid and complete donor chimerism in adult recipients of unrelated donor umbilical cord blood transplantation after reduced-intensity conditioning |
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| Author(s): Barker JN, Weisdorf DJ, DeFor TE, Blazar BR, Miller JS, Wagner JE |
| Source: BLOOD Volume: 102 Issue: 5 Pages: 1915-1919 Published: SEP 1 2003 |
| Times Cited: 178 References: 29 |
| Abstract: Reduced-intensity conditioning may reduce transplantation-related mortality in high-risk adults undergoing hematopoietic transplantation. We investigated unrelated donor umbilical cord blood (UCB) transplantation after such conditioning in 43 patients (median age, 49.5 years; range, 22-65 years) with a primary end point of donor engraftment. The first 21 patients received busulfan 8 mg/kg, fludarabine 200 mg/m(2), and 200 cGy of total body irradiation (Bu/Flu/TBI). Subsequent patients (n=22) received cyclophosphamide 50 mg/kg, fludarabine 200 mg/m(2), and 200 cGy TBI (Cy/Flu/TBI). UCB grafts (93%) were 1-2 HLA antigen-mismatched with the recipient and contained a median cryopreserved cell dose of 3.7x10(7) (range, 1.6x10(7)-6.0x10(7)) nucleated cells per kilogram of recipient body weight (NC/kg). Graft versus host disease (GVHD) prophylaxis was cyclosporin A to day 180 plus mycophenolate mofetil to day 30. The cumulative incidence of sustained donor engraftment was 76% (95% confidence interval [CI], 56%-96%) for Bu/Flu/TBI recipients and 94% (95% CI, 84%100%) for Cy/Flu/TBI recipients. The median day of neutrophil recovery (at least 0.5x10(9)/L) for engrafting Bu/Flu/TBI recipients was 26 days (range, 12-30 days) and for Cy/Flu/TBI recipients was 9.5 days (range, 5-28 days). Incidence of grades III-IV acute GVHD was 9% (95% CI, 1%-17%), and survival at 1 year was 39% (95% Cl, 23%-56%). These data demonstrate that 0-2 antigen mismatched UCB is sufficient to engraft most adults after reduced-intensity conditioning and is associated with a low incidence of severe acute GVHD. |
| Document Type: Article |
| Language: English |
| Reprint Address: Barker, JN (reprint author), Dept Med, Box 480,420 Delaware St SE, Minneapolis, MN 55455 USA |
Addresses:
1. Univ Minnesota, Blood & Marrow Transplant Program, Div Med & Pediat Hematol, Minneapolis, MN USA
2. Univ Minnesota, Blood & Marrow Transplant Program, Div Oncol, Minneapolis, MN USA
3. Univ Minnesota, Blood & Marrow Transplant Program, Div Transplantat, Minneapolis, MN USA |
| Publisher: AMER SOC HEMATOLOGY, 1900 M STREET. NW SUITE 200, WASHINGTON, DC 20036 USA |
| Subject Category: Hematology |
| IDS Number: 714ZH |
| ISSN: 0006-4971 |
| DOI: 10.1182/blood-2002-11-3337 |
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| | | | | | | | | Record from Web of Science® | | | | | | | | | |