Journal
BEST PRACTICE & RESEARCH CLINICAL HAEMATOLOGY
Volume 23, Issue 2, Pages 237-244Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.beha.2010.06.003
Keywords
cord blood; stem cell transplant; engraftment; leukemia
Categories
Funding
- Associazione Italiana Ricerca contro il Cancro AIRC
- Compagnia di San Paolo Torino
- Progetto CARIGE Cellule Staminali
- Progetto LIMONTE
- Ministero della Salute (Ricerca Finalizzata Ministeriale)
- Progetto Ministero, Progetto Ricerca Sanitaria Regionale - Regione Liguria
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Cord blood transplant (CBT) in adult patients is scarcely utilized because of the risk of graft failure or very delayed platelet recovery. To improve the capacity and the speed to engraft, we have developed an intra-bone (18) cord blood transplant technique. 75 patients with hematological malignancies, categorized by disease phase as early (18%), intermediate (20%) and advanced (62%), were transplanted. The median cell dose (TNC) infused was: 2.6 (1.35-5.4) x 10(7)/kg; the HLA disparity was: 12 cases 5/6, 62 cases = 4/6 and 1 case = 3/6 matched antigens. 72/75 patients engrafted (96%); median day of recovery of neutrophils (PMN) >500 x 10(9)/L and platelets (PLT) > 20 000 x 10(9)/L was: 23 (14-44) and 35 (16-70) days respectively. The outcomes at 2 years according to Kaplan-Meier are: OS = 46% +/- 5; RI = 18% +/- 2; NRM = 39% +/- 5. Acute GVHD incidence/severity was: grade 0-I = 64%, II = 14%, III-IV = 0%. The incidence of Chronic GVHD was globally low but in 3 cases was very severe. Intra-bone CBT is associated with high rate of engraftment, early and robust platelet recovery, low incidence of acute GVHD. A very promising aspect is that the relapse rate is low considering the advanced phase of the disease in two/thirds of patients. A suitable CBU was found for nearly every patient searching for a CBU. Therefore, IB CBT extends the possibility to transplant any patient for whom this approach represents the sole possibility of long-term survival. (C) 2010 Elsevier Ltd. All rights reserved.
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