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Successful Engraftment After Reduced-Intensity Umbilical Cord Blood Transplantation for Adult Patients with Advanced Hematological Diseases

¹ Department of Hematology, Toranomon Hospital; ² Hematopoietic Stem-cell Transplantation Unit, National Cancer Center Hospital; ³ Department of Hematology and Rheumatology, JR Tokyo General Hospital; ⁴ Department of Internal Medicine, Higashijyujyo Hospital; and ⁵ Department of Internal Medicine, Tokyo Metropolitan Police Hospital, Tokyo, Japan

ABSTRACT

Purpose: The purpose of this research was to evaluate the feasibility of reduced-intensity unrelated cord-blood transplantation (RI-UCBT) in adult patients with advanced hematological diseases.

Experimental Design: Thirty patients (median age, 58.5 years; range, 20–70 years) with advanced hematological diseases underwent RI-UCBT at Toranomon Hospital between September 2002 and August 2003. Preparative regimen composed of fludarabine 25 mg/m² on days –7 to –3, melphalan 80 mg/m² on day –2, and 4 Gy total body irradiation on day –1. Graft-versus-host disease prophylaxis was composed of cyclosporin alone.

Results: Twenty-six patients achieved primary neutrophil engraftment after a median of 17.5 days. Median infused total cell dose was 3.1 x 10⁷/kg (range, 2.0–4.3 x 10⁷/kg). Two transplant-related mortalities occurred within 28 days of transplant, and another 2 patients displayed primary graft failure. Cumulative incidence of complete donor chimerism at day 60 was 93%. Grade II-IV acute graft-versus-host disease occurred in 27% of patients, with median onset 36 days. Primary disease recurred in 3 patients, and transplant-related mortality within 100 days was 27%. Estimated 1-year overall survival was 32.7%. Excluding 7 patients with documented infection, 19 patients displayed noninfectious fever before engraftment (median onset, day 9). Manifestations included high-grade fever, eruption, and diarrhea. The symptoms responded well to corticosteroid treatments in 7 of 13 treated patients.

Conclusion: This study demonstrated the feasibility of RI-UCBT in adults.

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