We conducted a single-arm prospective study in 50 patients who received the combination of an haploidentical stem cell graft and an unrelated umbilical cord blood unit for the treatment of hematological malignancies. The median time for neutrophil engraftment was 13 days (11-20 days), and for platelets was 15 days (11-180 days). All surviving patients attained complete haploidentical engraftment except three patients who presented a mixed engraftment with increasing cord blood and decreasing haplo mismatch chimerism during the first 4 months after transplantation. The cumulative incidence of grade II-IV acute GVHD was 20% ± 0.327% at day þ 100, and the incidence of chronic GVHD was 19.26% ± 1.0% at 1 year. The 1-year cumulative incidence of relapse was 19.78%±1%, and the TRM was 16.2%±0.54%. At 1 year, overall survival was 78.6%±7.6% and PFS 64.0%±11.0%. The BU/CY-based conditional regimen showed a significant superiority over TBI/CY on PFS (relative risk ¼ 5.012, 95% confidence interval, 1.146-21.927, P ¼ 0.032). In conclusion, the co-infusion of an unrelated cord blood unit may potentially improve the outcome of haploidentical allogeneic hematopoietic SCT.

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In order to determine the clinical impact of CD34؉ cell selected autologous transplantation in multiple myeloma (MM), we have performed a retrospective case-controlled analysis comparing 21 MM patients receiving high-dose melphalan and autologous transplantation with CD34؉ peripheral blood stem cells (PBSC) as front-line therapy to 21 control patients receiving unselected products. Case matching was performed using the following criteria: age and ␤2-microglobulin at diagnosis and disease status at the time of transplantation. Both cohorts were homogeneous in term of induction treatment and conditioning regimen. Patients were collected for CD34؉ selection after priming with G-CSF alone. Significantly fewer CD34؉ cells/kg were infused to patients in the selected group as compared to patients in the control group: 2.2 (range 0.5-14.3) vs 9.4 (range 1.1-15) (P Ͻ 0.001). The median time to neutrophil recovery у0.05 ؋ 10 9 /l was 10 days for the CD34 ؉ group and 9.5 days for the control group (P ‫؍‬ 0.357). The median time to platelet recovery у 20 ؋ 10 9 /l was 9 days for the CD34 ؉ group and 4.5 days for the control group (P ‫؍‬ 0.005). Response rates were comparable in both groups (85.7% in the CD34 ؉ group vs 90.4% in the control group). At 3 years, event-free survival (32% in the CD34 ؉ group vs 39% in the control group) and overall survival (85% in the CD34 ؉ group vs 79% in the control group) were not significantly different. Finally, use of unselected products dramatically reduced the cost of the transplantation procedure. This study shows that CD34؉ cell selected autologous transplantation is more expensive than transplantation with unselected products and does not improve the clinical outcome of patients with MM. Leukemia (2000) 14, 1815-1820.

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