Summary:Allogeneic hematopoietic stem cell transplantation (HSCT) has been performed mainly for young patients due to concern about the high incidence of treatmentrelated mortality (TRM). Recent advances to reduce TRM by using peripheral blood stem cells or nonmyeloablative conditioning regimens have increased the age limit for this procedure, and correctly identifying the indication for transplant is essential for older patients. In this study, we analyzed data from 398 patients aged 50 or over selected from 5147 patients, who received conventional allogeneic HSCT (c-HSCT). Patients aged 50 or older showed inferior outcomes for TRM and overall survival (OS). Mulitivariate analyses confirmed that an age of 50 or over was an independent risk factor for TRM (Po0.0001) and OS (Po0.0001). Among patients aged 50 or older, increasing age remained an adverse factor for OS (P ¼ 0.0213). Regimens including total-body irradiation (TBI) correlated with a higher risk of TRM and a lower OS for older patients (P ¼ 0.0095 and 0.0303, respectively). These findings indicate that allogeneic c-HSCT should be offered to patients over 50 years only if the increased risk of TRM is acceptable, and that a non-TBI regimen is preferable when the transplant is performed.

No abstract

Summary. Cryopreserved umbilical cord blood (CB) from unrelated donors can restore haematopoiesis after myeloablative therapy in patients with haematological malignancy. We investigated the clinical outcomes of CB transplantation (CBT) with special emphasis on graft-versus-host disease (GVHD) prophylaxis. Patients with haematological malignancies (n ¼ 216) received intensive chemotherapy or immunosuppressive therapy, followed by transplantation of cryopreserved CB cells from unrelated donors. The clinical outcomes, i.e. haematological reconstitution, the incidence of acute or chronic GVHD, relapse and event-free survival (EFS), were evaluated. The estimated probability of neutrophil recovery was 88AE2%. The median follow-up for the survivors was 557 d (range 21-1492 d). The overall and EFS rates were 32AE6% and 25AE5%, respectively, 3AE5 years after transplantation. Multivariate analysis using Cox's proportional hazards model showed that high-risk disease status at CBT and single-drug GVHD prophylaxis were associated with worse 2-year EFS rates [P ¼ 0AE0013, relative risk (RR) 1AE90, 95% confidence interval (CI) 1AE28-2AE81 and P ¼ 0AE0007, RR 1AE91, 95% CI 1AE31-2AE79 respectively). Age at CBT had no significant influence on EFS. Cryopreserved CB from unrelated donors can restore haematopoiesis in patients with haematological malignancy. Although the incidence is low, the prophylaxis for acute GVHD is an important factor for survival of CBT from unrelated donors. A high rate of suitable donors was found, with a probability of 1 to every 18 CB units, when compared with human leucocyte antigen matching at other haematopoietic stem cell banks.Keywords: cord blood transplantation, unrelated donor, GVHD prophylaxis, haematological malignancy, Japanese cord blood bank network.Haematopoietic stem cell transplantation (HSCT), using cells from a human leucocyte antigen (HLA)-matched sibling or unrelated bone marrow (UBM) donors, has been successful in treating patients with high-risk or relapsed haematological malignancies, syndromes of bone marrow failure, hereditary immunodeficiencies and Correspondence: Keiichi Isoyama, MD,

In UCB samples, alphaGalCer-pulsed DCs and NKT cells acted together to enhance NK cytotoxicity in vitro.

No abstract