Immunological reconstitution after cord blood transplantation for an adult patient

Nagayama, Hitomi; Nakayama, K; Yasuo, K; Takagi, Kenji; K, Dan; Yamashita, Naohide; Asano, Shigetaka; Takahashi, Tetsuya

doi:10.1038/sj.bmt.1701876

Cited by 8 publications

(8 citation statements)

References 6 publications

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“…14 Anecdotal case reports of UD-UCBT and small series comprising less than 10 patients have not been taken into consideration. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] To comprehend the extraordinary increase in UD-UCBT activity in recent years, we should note that, as of December 1997, a review of reports in the literature 31 collected data from only 43 recipients of UD-UCBT, of whom only four were adults. In fact, the first report of UD-UCBT in an adult patient with chronic myelogenous leukemia was published in 1996.…”

Section: Clinical Experience With Ud-ucbt In Adultsmentioning

confidence: 99%

Unrelated donor umbilical cord blood transplantation in adults

Sanz

2002

Leukemia

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Umbilical cord blood (UCB) has emerged as an appealing alternative source of hematopoietic stem cells for unrelated donor transplantation. Shorter time to transplant and an improved chance of finding a suitable graft are evident advantages over bone marrow transplantation from unrelated donors. The majority of UCB transplants from unrelated donors have been performed in children, but the number in adults has been growing steadily in recent years. We review herein the reported experience with that source of hematopoietic stem cells in adults with hematological malignancies. The available data support the use of UCB transplantation from unrelated donors for young adults with hematological malignancies and no appropriate bone marrow donor, especially for those requiring urgent transplantation.

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Section: Clinical Experience With Ud-ucbt In Adultsmentioning

confidence: 99%

Unrelated donor umbilical cord blood transplantation in adults

Sanz

2002

Leukemia

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“…A lower incidence of, and reduced GVHD may permit early termination of immunosuppressive therapy, resulting in early immune reconstitution after CBT. 10 Thomson et al 20 examined immune recovery after unrelated umbilical cord blood transplantation in childhood. They reported similar immune recovery after CBT, without delayed CD8 + T cell recovery, compared to that reported for other stem cell sources.…”

Section: Total 20mentioning

confidence: 99%

“…Although several studies have examined T cell recovery after CBT, 4,10,[20][21][22] little is known about immune reconstitution after myeloablative doses of irradiation. We documented the early immune reconstitution after a two loci HLA-mismatched CBT in an adult recipient compared to that seen with bone marrow, avoiding the use of ATG and mPSL in the conditioning and GVHD prophylaxis.…”

Section: Total 20mentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10]23 The relatively weak cord blood T cell-derived effect via down-regulating FasL 12 may induce donor/recipient mixed chimeric tolerance, which allows autologous hematopoietic reconstitution and ameliorates the risk of GVHD. Avoidance of transplantrelated mortality including GVHD, and protection from opportunistic infections are the purposes of clinical intervention for ARS.…”

Section: Total 20mentioning

confidence: 99%

“…2 Main causes of death after allogeneic bone marrow transplantation for irradiated individuals are burns, acute GVHD and interstitial pneumonitis with or without adult respiratory distress syndrome (ARDS). 1,2 Umbilical cord blood is a useful stem cell source because the incidence and extent of acute GVHD associated with its use are low as compared to conventional bone marrow, [3][4][5][6][7][8][9][10] allowing for three HLA loci donor/recipient mismatching. 4,7,8 In addition, umbilical cord blood can be used for urgent triage for numerous victims without donor acquisition delay, because it has already been screened and cryopreserved.…”

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Transient hematopoietic stem cell rescue using umbilical cord blood for a lethally irradiated nuclear accident victim

Nagayama

Misawa

Tanaka

et al. 2002

Bone Marrow Transplant

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Summary:We performed stem cell rescue and allogeneic skin transplantation on a lethally neutron-irradiated nuclear accident victim. HLA-DRB1 mismatched unrelated umbilical cord blood cells (2.08 ؋ 10 7 /kg recipient body weight) were transplanted to an 8-10 Gy equivalent neutron-irradiated patient because of a lack of a suitable bone marrow or peripheral blood donor. Pre-transplant conditioning consisted of anti-thymocyte ␥-globulin alone, and GVHD prophylaxis was a combination of cyclosporine (CYA) and methylprednisolone (mPSL). Granulocyte colony-stimulating factor (G-CSF), erythropoietin (EPO), and thrombopoietin (TPO) were concurrently administered after transplantation. The absolute neutrophil count reached 0.5 ؋ 10 9 /l on day 15, the reticulocyte count rose above 1% on day 23, and the platelet count was over 50 ؋ 10 9 /l on day 27, respectively. Cytogenetic studies of blood and marrow showed donor/recipient mixed chimerism. Rapid autologous hematopoietic recovery was recognized after withdrawal of CYA and mPSL. Repeated pathological examinations of the skin revealed no evidence of acute GVHD. Eighty-two days after the irradiation, skin transplantation was performed to treat radiation burns. Almost 90% of the transplanted skin engrafted. Immunological examination after autologous hematopoietic recovery revealed an almost normal T cell count. However, immune functions were severely impaired. The patient died from infectious complication 210 days after the accident.

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Improvement of early mortality in single‐unit cord blood transplantation for Japanese adults from 1998 to 2017

Konuma

Kanda

Inamoto³

et al. 2020

American J Hematol

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The major limitation of cord blood transplantation (CBT) for adults remains the delayed hematopoietic recovery and higher incidence of graft failure, which result in a higher risk of early mortality in CBT. We evaluated early overall survival (OS), non‐relapse mortality (NRM), neutrophil engraftment, acute graft‐vs‐host disease, and cause of early death among 9678 adult patients who received single‐unit CBT in Japan between 1998 and 2017. The probability of OS at 100 days was 64.4%, 71.7%, and 78.9% for the periods 1998 to 2007, 2008 to 2012, and 2013 to 2017, respectively (P < .001). The cumulative incidences of NRM at 100 days during the same period were 28.3%, 20.8%, and 14.6%, respectively (P < .001). The cumulative incidences of neutrophil engraftment were also improved during the same period (P < .001). The most common cause of death within 100 days after CBT was bacterial infection in 1998 to 2007 and primary disease in the latter two time periods. Across the three time periods, the proportions of deaths from bacterial and fungal infection, graft failure, hemorrhage, sinusoidal obstructive syndrome, and organ failure decreased in a stepwise fashion. Landmark analysis of OS and NRM after 100 days showed that OS did not change over time in the multivariate analysis. Our registry‐based data demonstrated a significant improvement of early OS after CBT for adults over the past 20 years. The landmark analysis suggested that improvement of early mortality could lead to an improvement of long‐term OS after CBT.

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Immunological reconstitution after cord blood transplantation for an adult patient

Cited by 8 publications

References 6 publications

Unrelated donor umbilical cord blood transplantation in adults

Unrelated donor umbilical cord blood transplantation in adults

Transient hematopoietic stem cell rescue using umbilical cord blood for a lethally irradiated nuclear accident victim

Improvement of early mortality in single‐unit cord blood transplantation for Japanese adults from 1998 to 2017

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