Journal
BLOOD
Volume 105, Issue 3, Pages 1343-1347Publisher
AMER SOC HEMATOLOGY
DOI: 10.1182/blood-2004-07-2717
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Funding
- NCI NIH HHS [P30 CA008748, P01-CA65493] Funding Source: Medline
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Limited umbilical cord blood (UCB) cell dose compromises the outcome of adult UCB transplantation. Therefore, to augment graft cell dose, we evaluated the safety of the combined transplantation of 2 partially human leukocyte antigen (HLA)-matched UCB units. Twenty-three patients with high-risk hematologic malignancy (median age, 24 years; range, 13-53 years) received 2 UCB units (median infused dose, 3.5 x 10(7) nucleated cell [NC]/ kg; range, 1.1-6.3 x 10(7) NC/kg) after my-eloablative conditioning. All evaluable patients (n = 21) 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% of patients, with 1 unit predominating in all patients by day 100. Although neither nucleated or CD34(+) cell doses nor HLA-match predicted which unit would predominate, the predominating unit had a significantly higher CD3(+) dose (P <.01). Incidences of grades II-IV and III-IV acute GVHD were 65% (95% confidence interval [CI], 42%-88%) and 13% (95% Cl, 0%-26%), respectively. Disease-free survival was 57% (95% Cl, 35%-79%) at 1 year, with 72% (95% Cl, 49%-95%) of patients alive if they received transplants while in remission. Therefore, transplantation of 2 partially HLA-matched UCB units is safe, and may overcome the cell-dose barrier that limits the use of UCB in many adults and adolescents. (C) 2005 by The American Society of Hematology.
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