Umbilical Cord Blood Transplantation for Children with Thalassemia and Sickle Cell Disease

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 DRBI (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 x 10(7)/kg. The 2-year probability of DFS was 45% in patients who received grafts with cell dose > 5 x 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 x 10(7)/kg should be considered for transplantation for hemoglobinopathy. Biol Blood Marrow Transplant 17: 1375-1382 (2011) (C) 2011 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.