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Biol Blood Marrow Transplant. 2014 Dec;20(12):2015-22. doi: 10.1016/j.bbmt.2014.08.024. Epub 2014 Sep 22.

Haplo-cord transplantation using CD34+ cells from a third-party donor to speed engraftment in high-risk patients with hematologic disorders.

Author information

1
Department of Hematology, Gregorio Marañón Institute of Health Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: mi.kwon@salud.madrid.org.
2
Department of Hematology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
3
Department of Hematology, Gregorio Marañón Institute of Health Research, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
4
Department of Hematology, Hospital Duran i Reynals, Catalan Institute of Oncology, Barcelona, Spain.
5
Department of Immunology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
6
School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
7
Department of Hematology, Hospital Universitario Puerta de Hierro, Madrid, Spain; School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.

Abstract

Among the strategies to optimize engraftment of cord blood (CB) stem cell transplantation (SCT), single CB with the coinfusion of CD34(+) stem cells from an HLA-mismatched auxiliary donor (haplo-cord) provides a valid alternative for adult patients without a suitable donor. A total of 132 high-risk adult patients with hematological malignancies from 3 Spanish institutions underwent myeloablative haplo-cord SCT. The median age was 37 years and median weight was 70 kg; 37% had active disease. The median number of postprocessing CB total nucleated and CD34(+) cells was 2.4 × 10(7)/kg (interquartile range [IQR], 1.8 to 2.9) and 1.4 × 10(5)/kg (IQR, .9 to 2), respectively. Neutrophil engraftment occurred in a median of 11.5 days (IQR, 10.5 to 16.5) and platelet engraftment at 36 days (IQR, 25.5 to 77). Graft failure was 2% overall and only 9% for CB. Cumulative incidence of acute graft-versus-host disease (GHVD) grades II to IV was 21% and cumulative incidence of chronic GVHD was 21%. Median follow-up was 60 months (range, 3.5 to 163). Overall survival was 43.5%, event-free survival was 38.3%, nonrelapse mortality was 35%, and relapse was 20% at 5 years. Myeloablative haplo-cord SCT results in fast engraftment of neutrophils and platelets, low incidences of acute and chronic GVHD, and favorable long-term outcomes using single CB units with relatively low cell content. Moreover, CB cell dose had no impact on CB engraftment and survival in this study. Therefore, haplo-cord SCT expands donor availability while reducing CB cell dose requirements.

KEYWORDS:

Alternative donor; Cord blood transplantation; Haploidentical

PMID:
25255162
DOI:
10.1016/j.bbmt.2014.08.024
[Indexed for MEDLINE]
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