One or two umbilical cord blood cell units? Caveat emptor

Sanz, Jaime; Gale, Robert Peter

doi:10.1038/bmt.2016.277

Cited by 6 publications

(8 citation statements)

References 35 publications

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“…These observations are also in accordance with those made in patients receiving CBT after myeloablative conditioning [17–19, 30, 33, 38]. Subgroup analyses revealed no interaction between patient age at transplantation, patient gender, number of cells infused, disease type, disease status, HLA-matching, use of ATG and conditioning type (TCF versus other), and the associations between sCBT versus dCBT and GRFS or OS.…”

Section: Discussionsupporting

confidence: 87%

Single- or double-unit UCBT following RIC in adults with AL: a report from Eurocord, the ALWP and the CTIWP of the EBMT

et al. 2017

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BackgroundThe feasibility of cord blood transplantation (CBT) in adults is limited by the relatively low number of hematopoietic stem/progenitor cells contained in one single CB unit. The infusion of two CB units from different partially HLA-matched donors (double CBT) is frequently performed in patients who lack a sufficiently rich single CB unit.MethodsWe compared CBT outcomes in patients given single or double CBT following reduced-intensity conditioning (RIC) in a retrospective multicenter registry-based study. Inclusion criteria included adult (≥18 years) patients, acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL), complete remission (CR) at the time of transplantation, first single (with a cryopreserved TNC ≥ 2.5 × 107/kg) or double CBT between 2004 and 2014, and RIC conditioning.ResultsData from 534 patients with AML (n = 408) or ALL (n = 126) receiving a first single (n = 172) or double (n = 362) CBT were included in the analyses. In univariate analysis, in comparison to patients transplanted with a single CB, double CB recipients had a similar incidence of neutrophil engraftment but a suggestion for a higher incidence of grade II–IV acute GVHD (36 versus 28%, P = 0.08). In multivariate analyses, in comparison to single CBT recipients, double CBT patients had a comparable incidence of relapse (HR = 0.9, P = 0.5) and of nonrelapse mortality (HR = 0.8, P = 0.3), as well as comparable overall (HR = 0.8, P = 0.17), leukemia-free (HR = 0.8, P = 0.2) and GVHD-free, relapse-free (HR = 1.0, P = 0.3) survival.ConclusionsThese data failed to demonstrate better transplantation outcomes in adult patients receiving double CBT in comparison to those receiving single CBT with adequate TNC after RIC.Electronic supplementary materialThe online version of this article (doi:10.1186/s13045-017-0497-9) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 87%

Single- or double-unit UCBT following RIC in adults with AL: a report from Eurocord, the ALWP and the CTIWP of the EBMT

et al. 2017

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“…This regimen, first reported by our group in the UCBT setting, had been adopted as the standard for single-unit UCBT by the Spanish Group of Hematopoietic Stem Cell Transplant and demonstrated a high rate of engraftment, a good toxicity profile, and favorable long-term outcomes [8]. Within the Spanish Group of Hematopoietic Stem Cell Transplant platform, we used minimum cell dose requirements based on overall cellularity of the unit and not based on the recipient's body weight, based on our previous experience, in which the recipient's weight was never associated with engraftment and to facilitate unit selection [7,26]. The TBF regimen also showed superiority over other regimens in a study from the EBMT [27].…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Study Comparing Myeloablative Unrelated Umbilical Cord Blood Transplantation versus HLA-Haploidentical Related Stem Cell Transplantation for Adults with Hematologic Malignancies

Sanz

Montoro

Solano

et al. 2020

Biology of Blood and Marrow Transplantation

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“…Furthermore, adequate cryopreserved TNC dose might be also dependent on cell calculation based on ABW or IBW, particularly in overweight patients. Thus, the minimum threshold of cryopreserved TNC dose for single-unit CBT in adults remains unclear [55]. We previously reported the safety of single-unit CBT for adults with the low cryopreserved TNC dose (less than 2 × 10 7 /kg) [56].…”

Section: Discussionmentioning

confidence: 99%

Cryopreserved CD34 + Cell Dose, but Not Total Nucleated Cell Dose, Influences Hematopoietic Recovery and Extensive Chronic Graft-versus-Host Disease after Single-Unit Cord Blood Transplantation in Adult Patients

Konuma

Kato

Oiwa‐Monna

et al. 2017

Biology of Blood and Marrow Transplantation

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Low cryopreserved total nucleated cell (TNC) dose in a cord blood (CB) unit has been shown to be associated with engraftment failure and mortality after single-unit cord blood transplantation (CBT) in adults. Although CB banks offer specific characteristics of cryopreserved cell dose, such as TNC, CD34 cells, and colony-forming unit for granulocyte/macrophage (CFU-GM), the impact of each cell dose on engraftment and outcomes after single-unit CBT in adults remains unclear. We retrospectively analyzed the results of 306 CBTs for 261 adult patients in our institution between 1998 and 2016. The median age was 43 years (range, 16 to 68), the median actual body weight (ABW) was 56.2 kg (range, 36.2 to 104.0), the median ideal body weight (IBW) was 62.3 kg (range, 39.7 to 81.3), the median TNC dose was 2.46 × 10/ABW kg (range, 1.07 to 5.69), the median CD34 cell dose was .91 × 10/ABW kg (range, .15 to 7.75), and the median CFU-GM dose was 24.46 × 10/ABW kg (range, .04 to 121.81). Among patients who achieved engraftment, the speed of neutrophil, platelet, and red blood cell engraftment significantly correlated with CD34 cell dose, but not with TNC and CFU-GM dose, based on both ABW and IBW. In multivariate analysis, the incidence of extensive chronic graft-versus-host disease (GVHD) was significantly higher in patients receiving the highest CD34 cell dose, based on both ABW and IBW. Nevertheless, no cell dose was associated with survival, transplantation-related mortality, and relapse. In conclusion, cryopreserved CD34 cell dose was the best predictor for hematopoietic recovery and extensive chronic GVHD after CBT. The cryopreserved CD34 cell dose should be used for unit selection criteria in single-unit CBT for adults.

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One or two umbilical cord blood cell units? Caveat emptor

Cited by 6 publications

References 35 publications

Single- or double-unit UCBT following RIC in adults with AL: a report from Eurocord, the ALWP and the CTIWP of the EBMT

Single- or double-unit UCBT following RIC in adults with AL: a report from Eurocord, the ALWP and the CTIWP of the EBMT

Prospective Randomized Study Comparing Myeloablative Unrelated Umbilical Cord Blood Transplantation versus HLA-Haploidentical Related Stem Cell Transplantation for Adults with Hematologic Malignancies

Cryopreserved CD34 + Cell Dose, but Not Total Nucleated Cell Dose, Influences Hematopoietic Recovery and Extensive Chronic Graft-versus-Host Disease after Single-Unit Cord Blood Transplantation in Adult Patients

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