Umbilical Cord Blood Transplantation in adults: Results of the prospective Cord Blood Transplantation (COBLT)

被引:91
作者
Cornetta, K
Laughlin, M
Carter, S
Wall, D
Weinthal, J
Delaney, C
Wagner, J
Sweetman, R
McCarthy, P
Chao, N
机构
[1] Indiana Univ, Sch Med, Dept Med & Mol Genet, Indianapolis, IN 46202 USA
[2] Case Western Reserve Univ, Cleveland, OH 44106 USA
[3] EMMES Corp, Rockville, MD USA
[4] Texas Transplant Inst, San Antonio, TX USA
[5] N Texas Hosp Children, Dallas, TX USA
[6] Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA
[7] Univ Minnesota, Minneapolis, MN 55455 USA
[8] City Hope Natl Med Ctr, Duarte, CA 91010 USA
[9] Roswell Pk Canc Inst, Buffalo, NY 14263 USA
[10] Duke Univ, Durham, NC 27706 USA
关键词
cord blood; hematopoietic stein cell transplantation; COBLT;
D O I
10.1016/j.bbmt.2004.11.020
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The Cord Blood Transplantation study group conducted a prospective study of unrelated cord blood transplantation (CBT) to better define the role of this stem cell source for subjects requiring unrelated allogeneic transplantation. We report on 1 stratum of the study designated for adult subjects. The primary end point of the study was survival at 180 days. Secondary end points included engraftment, graft-versus-host disease, relapse, and long-term survival. Eligibility criteria for malignant and nonmalignant diseases were specified. Subjects with active central nervous system disease, Karnofsky performance status <70%, grade 3 or 4 or primary myelofibrosis, or suitable related donors were excluded. Enrollment required a single cord blood unit containing >107 nucleated cells per kilogram of recipient weight and matched at greater than or equal to4 HLA-A and -B (low or intermediate resolution) and -DRB1 (high resolution) types. Thirty-four subjects were entered, with a median age of 34.5 years (range, 18.2-55 years). Most subjects (n = 23) had a 4 of 6 match, 10 subjects bad a 5 of 6 match, and I subject had a 6 of 6 match. Diagnoses at transplantation included acute myclogenous leukemia (n 19), acute lymphoblastic leukemia (n = 9), chronic myelogenous leukemia (n = 3), myelodysplastic syndrome (n 1), paroxysmal nocturnal hemoglobinuria (PNH) (n = 1), and non-Hodgkin lymphoma (n = 1); 94% were classified as poor risk according to National Marrow Donor Program criteria. Subjects received total body irradiation/cyclophosphamide (n = 27) or busulfan/melphalan (n = 7) conditioning regimens. Four subjects died before CBT and are described here but are not included in the main analysis. The cumulative incidence rates and median times to neutrophil (500/muL) and platelet (>20 000/muL) engraftment were 0.66 by day 42 (median, 31 days) and 0.35 by day 180 (median, 117 days). The cumulative incidence rate for grade II-IV GVHD was 0.34 by day 100. For the primary end point, survival at 180 days, Kaplan-Meier survival estimates were 0.30 (95% confidence interval, 0.14-0.46) by day 180 after transplantation. To date there are 2 survivors, and both are >36 months from enrollment. A retrospective analysis was performed by using high-resolution BILA-A and -B typing, which revealed that approximately one third of subjects had I or more additional B:LA mismatches compared with results of low- or intermediate-resolution HLA typing. The findings of high treatment-related mortallity and slow engraftment kinetics indicate that CBT should continue to be performed in specialized centers with a research focus on cord blood cells. (C) 2005 American Society for Blood and Marrow Transplantation.
引用
收藏
页码:149 / 160
页数:12
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