High incidence of graft failure in unrelated cord blood transplantation using a reduced-intensity preparative regimen consisting of fludarabine and melphalan

Abstract

High incidence of graft failure in unrelated cord blood transplantation using a reduced-intensity preparative regimen consisting of fludarabine and melphalan

Better outcomes of modified myeloablative conditioning without antithymocyte globulin versus myeloablative conditioning in cord blood transplantation for hematological malignancies: A retrospective (development) and a prospective (validation) study

“…Similar to our results, some authors have reported that lower conditioning intensity is associated with delayed immune reconstitution and a higher incidence of GF 8, 9. Notably, conditioning type (TBI‐based or Bu‐based) was significantly different between the MAC group and MMAC group in the retrospective study, and TBI has always been a favorable factor in improving neutrophil engraftment in CBT 22, 23.…”

“…GF can be due to immunological rejection of donor cells by residual host lymphocytes, the presence of donor‐specific anti‐HLA antibodies (DSA), or nonimmunologic mechanisms such as poor stem cell viability and viral infections 6, 7. Particularly, factors associated with GF in CBT can be inherently low stem cell doses, HLA mismatch, relative immaturity of CB lymphocytes and the increasing use of reduced intensity conditioning with CBT 4, 8, 9. Ioannis et al .…”

Future of cord blood for oncology uses

“…These older patients make up a large population of patients with hematological malignancies who would potentially benefit from RIC UCB transplantation strategies, and this is reflected in the growing number of publications in the area. [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] Outcomes after RIC UCB transplantation have been encouraging, with most patients achieving prompt neutrophil recovery and donor chimerism plus promising PFS and OS (Table 3). There is variability in the incidence of acute (10-60%) and chronic (10-40%) GVHD, which may be related to differences in the conditioning regimen, post transplantation immunosuppression, and the number of UCB units composing the graft and ethnic heterogeneity of the study population.…”

Feasibility of umbilical cord blood transplantation with a myeloablative, reduced toxicity-conditioning regimen

“…To reduce regimen-related toxicity, non-TBI containing regimens that employ agents such as fludarabine (Flu) and either melphalan (Mel) or Bu have been attempted, but are associated with a high rate of graft failure. 5,6 In contrast, with CBT using a conditioning regimen consisting of Flu, Mel and TBI, a high rate of TRM has been documented. 4 A less toxic conditioning regimen of sufficient intensity to achieve engraftment is therefore required.…”