Outcome following unrelated cord blood transplant in 136 patients with malignant and non-malignant diseases: a report from the Australian and New Zealand children's haematology and oncology group

Abstract

Unrelated umbilical cord blood (UCB) is an alternative stem cell source for paediatric patients lacking a matched related or unrelated marrow donor. We report the results of all paediatric unrelated UCB transplants performed in Australia and New Zealand over a 10-year period. A total of 135 patients were transplanted, 100 for malignant disease (74%) and 35 for non-malignant disorders. The majority (88%) of patients received an HLA-mismatched graft. The median infused total nucleated cell dose was 4.7 Â 10 7 /kg and CD34 þ count 1.9 Â 10 5 /kg. Neutrophil engraftment occurred in 83% of patients by day 42 (median 23 days) and platelet engraftment in 55% by day 60 (median 56 days). Grades II-IV and III-IV acute GVHD occurred in 41 and 18% of patients, respectively. TRM and overall survival 1-year post transplant were 32 and 61%, respectively. A higher probability of neutrophil recovery (P ¼ 0.004) and faster time to recovery (median 18 days vs 26 days, P ¼ 0.008) were observed in recipients of a cord unit with a CD34 cell dose X1.7 Â 10 5 /kg. Our results support selection of cord units with CD34 cell doses X1.7 Â 10 5 /kg to promote faster engraftment, improve survival and lower TRM.

Challenges in Umbilical Cord Blood Stem Cell Banking for Stem Cell Reviews and Reports

“…Disease-free survival was best for those patients who received a 6/6 matched cord blood (60% vs 38%) and comparable for those patients who received 8/ 8 matched unrelated bone marrow or 4/6 or 5/6 matched cord blood units. The Australian and New Zealand groups recently reported a 5 year survival of 41% for 100 children with malignant diseases and a 65% 5 year survival for 36 children with non-malignant diseases [14]. Similar results have been reported by the American COBLT study [15].…”

Cord blood transplantation in Western Australia

“…Although a trend towards improved neutrophil engraftment with a CD34+ cell dose greater than 1.7 × 10 5 was seen, this did not reach statistical significance (data not shown). The significance of cell dose on overall survival seen in this cohort was not observed in a recent review of 136 Australian paediatric patients who received a cord blood transplant 21 . In this study CD34+ cell dose was predictive of neutrophil engraftment but not of overall survival.…”

“…The significance of cell dose on overall survival seen in this cohort was not observed in a recent review of 136 Australian paediatric patients who received a cord blood transplant. 21 In this study CD34+ cell dose was predictive of neutrophil engraftment but not of overall survival. This discrepancy may be explained by the inclusion of adults in our cohort who had lower median TNC and CD34+ cell doses and likely contributed to the effects of the survival difference seen at lower transplanted cell doses.…”

Transplantation-Related Mortality, Graft Failure, and Survival after Reduced-Toxicity Conditioning and Allogeneic Hematopoietic Stem Cell Transplantation in 100 Consecutive Pediatric Recipients

“…In another recent study of children with leukemia and myelodysplastic syndrome (MDS), Shaw et al [9] reported a cumulative 3-year incidence of TRM after MAC allo-HSCT was 10% for MSD graft recipients, compared with 27% for matched unrelated donor (MUD) graft recipients. TRM in children after MAC and umbilical cord blood (UBC) transplantation (UCBT) is significantly higher, ranging from 20% to 52% [6,[10][11][12].…”