Umbilical Cord Blood Transplantation after a Reduced-Intensity Treatment Regimen: An Effective Strategy
Researchers from the University of Minnesota have reported a survival rate of almost 50% in adult patients with hematologic disease treated with umbilical cord blood transplantation following a regimen of Fludara® (fludarabine) and 200 cGy of total body irradiation (TBI). The details of this study appeared in an early on-line publication on June 13, 2007 in Blood.
Umbilical cord blood transplantation has emerged as a viable alternative for the treatment of patients with hematologic disease who lack a suitable related or unrelated donor. Most of the studies, to date, have utilized myeloablative regimens with an associated high treatment-related mortality. Studies in patients receiving related or unrelated donor stem cell transplants have suggested that this strategy can decrease transplant-related complications and allow transplants to be performed in older patients. The current study addresses the issue of whether or not a reduced-intensity transplant would be successful for preparation of patients for an umbilical cord blood transplant.
This study enrolled 110 adult patients with hematologic disease who were prepared for umbilical cord blood transplantation with a regimen of Fludara and low-dose TBI. Post-transplant immunotherapy was with cyclosporine and mycophenolate mofetil. Eighty-three percent of patients in this study received infusions of 2 separate cord blood collections.
Three quarters of the patients were selected for this trial due to age being 45 years or older and one quarter because of morbities prohibiting a myeloablative regimen. The median age was 51 years with the oldest patient being 79 years. Thirty-one percent of patients had acute leukemia and 35% had lymphoma with the remainder having chronic myeloid leukemia, myltiple myeloma, aplastic anemia, myelodysplastic syndrome and myelofibrosis.
Neutrophil recovery occurred in a median of 12 days and acute graft-versus host disease (GVHD) occurred in 22%. The incidence of chronic-GVHD was 23%. Transplant-related mortality was 26% at 3 years. Overall survival at 3 years was 45% with an event-free survival of 38%. Patients in better condition and with less advanced disease had better outcomes. These authors conclude that these results support the use of umbilical cord blood transplants in patients without a suitable related or unrelated stem cell donor.
Comments: These results are probably as good or better than those achieved with unrelated donors. One of the major advantages of an umbilical cord blood transplant is that this procedure can be rapidly performed. This is a major advantage since many patients progress and become unfit for transplantation while waiting for a live donor.
Refrences: Brunstein CG, Baker JN, Weisdorf J, et al. Umbilical cord blood transplantation after nonmyeloablative conditioning: impact on transplant outcomes in 110 adults with hematological disease.Blood. 2007; 10: 1182.
- Equivalent Results from Umbilical Cord Blood and Related Donor Stem Cell Transplants (2/7/2007)
- Japanese Study Shows Umbilical Cord Blood Transplants Superior to Unrelated Donor Transplants for Adults with Leukemia (1/10/2005)
- Co-Infusion of Peripheral Blood Stem Cells May Improve Umbilical Cord Blood Transplants in Adults (7/12/2005)
- European Study Updates Results of Umbilical Cord Blood Transplants in Adults (4/22/2005)
- Are Two Umbilical Cord Blood (UCB) Units Better Than One for Transplantation? (2/15/2005)
- Umbilical Cord Blood: Acceptable Source of Stem Cells for Adult Transplants (12/2/2004)
- Umbilical Cord Blood Transplantation Effective for Adult Patients with AML (1/5/2004)
- Unrelated Umbilical Cord Transplants Highly Successful for Adults with MDS (6/16/2003)
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