Single-unit umbilical cord blood transplantation from unrelated donors in adult patients with chronic myelogenous leukemia.

Abstract

Clinical studies focused on outcomes of umbilical cord blood transplantation (UCBT) for patients with chronic myelogenous leukemia (CML) in need of allogeneic stem cell transplantation and lacking an HLA-matched adult donor are limited. We analyzed the outcome of 26 adults with CML receiving single-unit UCBT from unrelated donors after myeloablative conditioning at a single institution. Conditioning regimens were based on combinations of thiotepa, busulfan, cyclophospamide or fludarabine, and antithymocyte globulin. At the time of transplantation, 7 patients (27%) were in first chronic phase (CP), 11 (42%) were in second CP, 2 (8%) were in accelerated phase (AP), and 6 (23%) were in blast crisis (BC). The cumulative incidence (CI) of myeloid engraftment was 88% at a median time of 22 days and was significantly better for patients receiving higher doses of CD34(+) cells. The CI of acute graft-versus-host disease (GVHD) grade II-IV was 61%, that of acute GVHD grade III-IV was 39%, and that of chronic extensive GVHD was 60%. Treatment-related mortality (TRM) was 41% for patients undergoing UCBT while in first or second CP and 100% for patients in AP or BC (P < .01). After a median follow-up of 8 years, none of the patients relapsed, giving an overall disease-free survival (DFS) at 8 years of 41%. The DFS for patients undergoing UCBT while in any CP was 59%. These results demonstrate that UCBT from unrelated donors can be a curative treatment for a substantial number of patients with CML. Advances in supportive care and better selection of cord blood units and patients are needed to improve TRM.

• Authors: Jaime Sanz, Pau Montesinos, Silvana Saavedra, Ignacio Lorenzo, Leonor Senent, Dolores Planelles, Luis Larrea, Guillermo Martín, Javier Palau, Isidro Jarque, Jesús Martínez, Javier de la Rubia, Federico Moscardó, David Martinez, Inés Gómez, María López, Miguel A Sanz, Guillermo F Sanz
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 16 Issue 11 Pg. 1589-95 (Nov 2010) ISSN: 1523-6536 [Electronic] United States
• PMID: 20553927 (Publication Type: Journal Article)
• Copyright: Copyright © 2010 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Blood Donors
• Cause of Death
• Cord Blood Stem Cell Transplantation (methods, mortality)
• Disease-Free Survival
• Female
• Graft Rejection (epidemiology)
• Graft Survival
• Graft vs Host Disease (diagnosis, epidemiology)
• Histocompatibility
• Humans
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive (diagnosis, therapy)
• Leukocyte Count
• Male
• Middle Aged
• Neutrophils (cytology)
• Platelet Count
• Recurrence
• Retrospective Studies
• Transplantation Chimera
• Treatment Outcome
• Young Adult