Transplantation of 2 partially HLA-matched umbilical cord blood units to enhance engraftment in adults with hematologic malignancy.
Level 4 - case-series / case-control
Uncontrolled prospective single-arm case series
PubMed 15466923 · doi:10.1182/blood-2004-07-2717
What was done
Twenty-three patients with high-risk hematologic malignancies (median age 24 years, range 13-53 years) received myeloablative conditioning followed by transplantation of 2 partially HLA-matched umbilical cord blood units. The median total infused nucleated cell dose was 3.5 x 10(7) cells/kg (range 1.1-6.3 x 10(7) cells/kg). Investigators evaluated engraftment kinetics, chimerism dynamics, acute graft-versus-host disease (GVHD), and 1-year disease-free and overall survival.
What was found
All 21 evaluable patients engrafted at a median of 23 days (range 15-41 days). At day 21, engraftment was derived from both donors in 24% of patients and a single donor in 76%, with 1 unit predominating in all patients by day 100. A significantly higher CD3+ cell dose predicted the predominating unit (P < .01), whereas total nucleated cell dose, CD34+ cell dose, and HLA-match did not. Grade II-IV acute GVHD occurred in 65% (95% CI, 42%-88%) and grade III-IV acute GVHD in 13% (95% CI, 0%-26%). Disease-free survival was 57% (95% CI, 35%-79%) at 1 year, and 72% (95% CI, 49%-95%) of patients were alive if transplanted while in remission.
Why it matters
Transplantation of two partially HLA-matched cord blood units provides a practical approach to overcome cell-dose limitations that historically restrict umbilical cord blood use in adult and adolescent patients.
Limits
Small sample size (n = 23, with 21 evaluable for engraftment), single-arm design without a randomized or concurrent control group, and no reporting of chronic GVHD or longer-term outcomes in the abstract.
Cited by
- supports A standard cord blood unit typically does not contain enough stem cells to successfully treat an adult bone marrow transplant recipient.