TY - JOUR
T1 - Feasibility of Reduced-Intensity Cord Blood Transplantation as Salvage Therapy for Graft Failure
T2 - Results of a Nationwide Survey of Adult Patients
AU - Waki, Fusako
AU - Masuoka, Kazuhiro
AU - Fukuda, Takahiro
AU - Kanda, Yoshinobu
AU - Nakamae, Mika
AU - Yakushijin, Kimikazu
AU - Togami, Katsuhiro
AU - Nishiwaki, Kaichi
AU - Ueda, Yasunori
AU - Kawano, Fumio
AU - Kasai, Masaharu
AU - Nagafuji, Koji
AU - Hagihara, Maki
AU - Hatanaka, Kazuo
AU - Taniwaki, Masafumi
AU - Maeda, Yoshinobu
AU - Shirafuji, Naoki
AU - Mori, Takehiko
AU - Utsunomiya, Atae
AU - Eto, Tetsuya
AU - Nakagawa, Hitoshi
AU - Murata, Makoto
AU - Uchida, Toshiki
AU - Iida, Hiroatsu
AU - Yakushiji, Kazuaki
AU - Yamashita, Takuya
AU - Wake, Atsushi
AU - Takahashi, Satoshi
AU - Takaue, Yoichi
AU - Taniguchi, Shuichi
N1 - Funding Information:
We thank the physicians in the participating centers who contributed to this survey. We also thank Yukiko Iisaka and Mihoko Kanazawa for their assistance with data collection, and Shin-ichiro Mori, Sung-Won Kim, Ryuji Tanosaki, Dai Maruyama, and Kensei Tobinai for their helpful discussions. This work was supported in part by grants from the Ministry of Health, Labor and Welfare, Japan . This article was presented in part as a poster presentation at the 48th Annual Meeting of the American Society of Hematology, Orlando, FL, USA, December 2006.
PY - 2011/6
Y1 - 2011/6
N2 - To evaluate whether rescue with cord blood transplantation (CBT) could improve the poor survival after graft failure (GF), we surveyed the data of 80 adult patients (median age, 51 years) who received CBT within 3 months of GF (primary 64, secondary 16), with fludarabine-based reduced-intensity regimens with or without melphalan, busulfan, cyclophosphamide, and/or 2-4 Gy total-body irradiation (TBI). A median number of 2.4 × 107/kg total nucleated cells (TNC) were infused, and among the 61 evaluable patients who survived for more than 28 days, 45 (74%) engrafted. The median follow-up of surviving patients was 325 days, and the 1-year overall survival rate was 33% despite poor performance status (2-4, 60%), carryover organ toxicities (grade 3/4, 14%), and infections (82%) prior to CBT. Day 100 transplantation-related mortality was 45%, with 60% related to infectious complications. Multivariate analysis showed that the infusion of TNC ≥2.5 × 107/kg and an alkylating agent-containing regimen were associated with a higher probability of engraftment, and that high risk-status at the preceding transplantation and grade 3/4 organ toxicities before CBT were associated with an increased risk of mortality. In conclusion, in an older population of patients, our data support the feasibility of CBT with a reduced-intensity conditioning regimen for GF.
AB - To evaluate whether rescue with cord blood transplantation (CBT) could improve the poor survival after graft failure (GF), we surveyed the data of 80 adult patients (median age, 51 years) who received CBT within 3 months of GF (primary 64, secondary 16), with fludarabine-based reduced-intensity regimens with or without melphalan, busulfan, cyclophosphamide, and/or 2-4 Gy total-body irradiation (TBI). A median number of 2.4 × 107/kg total nucleated cells (TNC) were infused, and among the 61 evaluable patients who survived for more than 28 days, 45 (74%) engrafted. The median follow-up of surviving patients was 325 days, and the 1-year overall survival rate was 33% despite poor performance status (2-4, 60%), carryover organ toxicities (grade 3/4, 14%), and infections (82%) prior to CBT. Day 100 transplantation-related mortality was 45%, with 60% related to infectious complications. Multivariate analysis showed that the infusion of TNC ≥2.5 × 107/kg and an alkylating agent-containing regimen were associated with a higher probability of engraftment, and that high risk-status at the preceding transplantation and grade 3/4 organ toxicities before CBT were associated with an increased risk of mortality. In conclusion, in an older population of patients, our data support the feasibility of CBT with a reduced-intensity conditioning regimen for GF.
KW - Allogeneic stem cell transplantation
KW - Cord blood transplantation
KW - Graft failure
KW - Reduced intensity
KW - Rejection
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U2 - 10.1016/j.bbmt.2010.09.005
DO - 10.1016/j.bbmt.2010.09.005
M3 - Article
C2 - 20849969
AN - SCOPUS:79956004870
SN - 1083-8791
VL - 17
SP - 841
EP - 851
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 6
ER -