Umbilical cord blood transplantation for children with thalassemia and sickle cell disease.

Abstract

We examined the efficacy of unrelated cord blood (CB) transplantation in children with thalassemia (n = 35) and sickle cell disease (n = 16), using data reported to 3 registries. Donor-recipient pairs were matched at HLA-A and -B (antigen level) and DRB1 (allele level) in 7 or HLA mismatched at 1 (n = 18), 2 (n = 25), or 3 loci (n = 1). Transplant conditioning was myeloablative (n = 39) or reduced intensity (n = 12). Neutrophil recovery with donor chimerism was documented in 24 patients; 11 patients developed grade II-IV acute graft-versus-host disease (aGVHD) and 10 patients, chronic GVHD (cGVHD). Overall survival (OS) and disease-free survival (DFS) were 62% and 21% for thalassemia and 94% and 50% for sickle cell disease (SCD), respectively. In multivariate analysis, engraftment rate (hazard ratio [HR] 2.2, P = .05) and DFS (HR 0.4, P = .01) were higher with cell dose >5 × 10(7)/kg. The 2-year probability of DFS was 45% in patients who received grafts with cell dose >5 × 10(7)/kg and 13% with lower cell dose. Primary graft failure was the predominant cause of treatment failure occurring in 20 patients with thalassemia and 7 patients with SCD. Primary graft failure was fatal in 5 patients with thalassemia. These results suggest that only CB units containing an expected infused cell dose >5 × 10(7)/kg should be considered for transplantation for hemoglobinopathy.

• Authors: Annalisa Ruggeri, Mary Eapen, Andromachi Scaravadou, Mitchell S Cairo, Monica Bhatia, Joanne Kurtzberg, John R Wingard, Anders Fasth, Luca Lo Nigro, Mouhab Ayas, Duncan Purtill, Karim Boudjedir, Wagnara Chaves, Mark C Walters, John Wagner, Eliane Gluckman, Vanderson Rocha, Eurocord Registry, Center for International Blood and Marrow Transplant Research, New York Blood Center
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 17 Issue 9 Pg. 1375-82 (Sep 2011) ISSN: 1523-6536 [Electronic] United States
• PMID: 21277376 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2011 American Society for Blood and Marrow Transplantation. All rights reserved.

Topics

• Anemia, Sickle Cell (mortality, therapy)
• Cell Count
• Child
• Cord Blood Stem Cell Transplantation (adverse effects, methods, statistics & numerical data)
• Female
• Graft Survival
• Graft vs Host Disease
• Histocompatibility Testing
• Humans
• Male
• Neutrophils
• Registries
• Survival Analysis
• Thalassemia (mortality, therapy)
• Transplantation Chimera
• Transplantation Conditioning (methods)
• Treatment Outcome