Document Detail


Rapid and complete donor chimerism in adult recipients of unrelated donor umbilical cord blood transplantation after reduced-intensity conditioning.
MedLine Citation:
PMID:  12738676     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Reduced-intensity conditioning may reduce transplantation-related mortality in high-risk adults undergoing hematopoietic transplantation. We investigated unrelated donor umbilical cord blood (UCB) transplantation after such conditioning in 43 patients (median age, 49.5 years; range, 22-65 years) with a primary end point of donor engraftment. The first 21 patients received busulfan 8 mg/kg, fludarabine 200 mg/m2, and 200 cGy of total body irradiation (Bu/Flu/TBI). Subsequent patients (n = 22) received cyclophosphamide 50 mg/kg, fludarabine 200 mg/m2, and 200 cGy TBI (Cy/Flu/TBI). UCB grafts (93%) were 1-2 HLA antigen-mismatched with the recipient and contained a median cryopreserved cell dose of 3.7 x 107 (range, 1.6 x 107-6.0 x 107) nucleated cells per kilogram of recipient body weight (NC/kg). Graft versus host disease (GVHD) prophylaxis was cyclosporin A to day 180 plus mycophenolate mofetil to day 30. The cumulative incidence of sustained donor engraftment was 76% (95% confidence interval [CI], 56%-96%) for Bu/Flu/TBI recipients and 94% (95% CI, 84%-100%) for Cy/Flu/TBI recipients. The median day of neutrophil recovery (at least 0.5 x 109/L) for engrafting Bu/Flu/TBI recipients was 26 days (range, 12-30 days) and for Cy/Flu/TBI recipients was 9.5 days (range, 5-28 days). Incidence of grades III-IV acute GVHD was 9% (95% CI, 1%-17%), and survival at 1 year was 39% (95% CI, 23%-56%). These data demonstrate that 0-2 antigen mismatched UCB is sufficient to engraft most adults after reduced-intensity conditioning and is associated with a low incidence of severe acute GVHD.
Authors:
Juliet N Barker; Daniel J Weisdorf; Todd E DeFor; Bruce R Blazar; Jeffrey S Miller; John E Wagner
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2003-05-08
Journal Detail:
Title:  Blood     Volume:  102     ISSN:  0006-4971     ISO Abbreviation:  Blood     Publication Date:  2003 Sep 
Date Detail:
Created Date:  2003-08-21     Completed Date:  2003-10-02     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  7603509     Medline TA:  Blood     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1915-9     Citation Subset:  AIM; IM    
Affiliation:
Divisions of Medical and Pediatric Hematology, Oncology and Transplantation, University of Minnesota Blood and Marrow Transplant Program, Minneapolis, MN, USA. barke014@tc.umn.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Busulfan / administration & dosage
Cord Blood Stem Cell Transplantation*
Fetal Blood
Graft Survival
Graft vs Host Disease / drug therapy,  genetics*,  mortality*
Humans
Immunosuppressive Agents / administration & dosage
Incidence
Middle Aged
Recurrence
Risk Factors
Survival Rate
Transplantation Chimera*
Transplantation Conditioning*
Vidarabine / administration & dosage,  analogs & derivatives*
Grant Support
ID/Acronym/Agency:
P01-CA65493/CA/NCI NIH HHS; R01 HL 63452/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents; 21679-14-1/fludarabine; 55-98-1/Busulfan; 5536-17-4/Vidarabine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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