Preinfusion variables predict the predominant unit in the setting of reduced-intensity double cord blood transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 41; no. 6; pp. 523 - 529
• Main Authors: Haspel, R L, Kao, G, Yeap, B Y, Cutler, C, Soiffer, R J, Alyea, E P, Ho, V T, Koreth, J, Dey, B R, McAfee, S L, Attar, E C, Spitzer, T, Antin, J H, Ballen, K K
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.03.2008; Nature Publishing Group
• Subjects: Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Agents - administration & dosage; Biological and medical sciences; Blood; Bone marrow, stem cells transplantation. Graft versus host reaction; Care and treatment; CD34 antigen; Cell Biology; Chimerism; Cord blood; Cord Blood Stem Cell Transplantation; Diagnosis; Engraftment; Erythroblasts - transplantation; Female; Fetal blood; Fludarabine; Graft Survival; Health aspects; Hematology; Hematopoiesis; Hodgkin's disease; Humans; Immunosuppressive Agents - administration & dosage; Internal Medicine; Leukocytes (neutrophilic); Macrocyclic Compounds - administration & dosage; Male; Medical sciences; Medicine; Medicine & Public Health; Melphalan; Middle Aged; Mycophenolic Acid - administration & dosage; Mycophenolic Acid - analogs & derivatives; original-article; Parameter identification; Physiological aspects; Predictive Value of Tests; Public Health; Receptors, Complement 3b - metabolism; Risk factors; Stem cell transplantation; Stem Cells; Thymoglobulin; Time Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Chimera; United States; double cord blood transplant; engraftment; chimerism; Hematology; Stem cell; Hematopoietic cell; Homograft; Non myeloablative treatment; Blood; Blood cell; Engraftment; Graft; Chimerism; Umbilical cord; Predictive factor
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705933

Double cord blood transplantation (DCBT) may overcome the slow hematopoietic recovery and engraftment failure associated with infusion of a single cord blood unit. In DCBT, only one unit typically contributes to long-term hematopoiesis, but little is known about factors affecting cord predominance. As results from a phase I trial suggested that order of infusion may affect cord predominance, we analyzed the effect of preinfusion variables on chimerism patterns of 38 patients enrolled in the initial study and a subsequent phase II trial. All patients were treated with a reduced-intensity conditioning (RIC) regimen of fludarabine, melphalan and thymoglobulin followed by DCBT. By day 100, 66% of patients had hematopoiesis derived from a single cord blood unit. Higher post-thaw total nucleated cell and CD34+ cell dose were associated with cord predominance and in 68% of patients ( P =0.03); the predominant cord blood unit was infused first. Only the post-thaw CD34+ cell dose of the predominant unit predicted time to both neutrophil and platelet engraftment. Although based on a small number of patients, our results identify parameters that may affect cord predominance and engraftment in the setting of DCBT following RIC and suggest possible strategies for selecting infusion order for cord blood units.