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Cord Blood Stem Cells

Pre-transplant prognostic factors for patients with high-risk leukemia undergoing an unrelated cord blood transplantation

Bone Marrow Transplantation volume 33, pages 1097–1105 (2004)Cite this article

Summary:

From July 1995 to December 2001, 42 patients with leukemia aged 1–42 years underwent cord blood transplant (CBT) from unrelated, ⩽2 antigen HLA mismatched donors. In all, 26 patients were in ⩽2nd complete remission and 16 in more advanced phase. Conditioning regimens, graft-versus-host disease (GVHD) prophylaxis and supportive policy were uniform for all patients. The cumulative incidence of engraftment was 90% (95% CI: 0.78–0.91). The cumulative incidence of III–IV grade acute- and chronic-GVHD was 9% (95% CI: 0.04–0.24) and 35% (95% CI: 0.21–0.60), respectively. The 4-year cumulative incidence of transplant-related mortality (TRM) and relapse was 28% (95% CI: 0.17–0.47) and 25% (95% CI: 0.14–0.45), respectively. The 4-year overall survival (OS), leukemia-free survival (LFS) and event-free survival (EFS) were 45% (95% CI: 0.27–0.63), 47% (95% CI: 0.30–0 .64) and 46% (95% CI: 0.30–0.62), respectively. In multivariate analysis, the most important factor affecting outcomes was the CFU-GM dose, associated with CMV serology (P=0.003 and 0.04, respectively) in influencing OS and with patient sex (P=0.008 and 0.03, respectively) in influencing LFS. Finally, CFU-GM dose was the only factor that affected EFS significantly (P=0.02). In conclusion, the infused cell dose expressed as in vitro progenitor cell growth is highly predictive of outcomes after an unrelated CBT and should be considered the main parameter in selecting cord blood units for transplant.

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Acknowledgements

This work was supported in part by grants from AIRC, MIUR, ROMAIL, EEC for Eurocord BIOMED II QLRT-1999-00380, P.F.Min.Salute 2001,01,X,000177. We thank Professor Giuseppe Cimino for molecular study on chimerism, Dr Maria Rosaria De Cuia for cytogenetics, Dr Luca Laurenti for HLA typing and Dr Ippolita Rana for medical assistance. We thank also Esterina Livesi, Mirella Gasparrini and the entire staff of the ‘G Papa’ Bone Marrow Transplantation Units for providing excellent care of our patients.

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Authors and Affiliations

  1. Department of Cell Biotechnology and Hematology, University ‘La Sapienza’, Rome

    A P Iori, R Cerretti, L De Felice, M Screnci, L Cerilli, G Gentile, M L Moleti, F Giona, F Agostini, I Pasqua, M P Perrone, A M Testi, P Martino, F Mandelli & W Arcese

  2. Istituti Fisioterapici Ospitalieri, Istituto Regina Elena, Rome

    A Mengarelli & A Romano

  3. Division of Pediatric Hematology, Bambino Gesù Hospital, Rome

    M Caniglia, M R Pinto & G De Rossi

  4. Institute of Radiotherapy, University ‘La Sapienza’, Rome

    L Grapulin

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Correspondence to W Arcese.

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Iori, A., Cerretti, R., De Felice, L. et al. Pre-transplant prognostic factors for patients with high-risk leukemia undergoing an unrelated cord blood transplantation. Bone Marrow Transplant 33, 1097–1105 (2004). https://doi.org/10.1038/sj.bmt.1704500

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