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Clinical Trial
. 2013 Jan 31;121(5):752-8.
doi: 10.1182/blood-2012-08-449108. Epub 2012 Dec 9.

Double unit grafts successfully extend the application of umbilical cord blood transplantation in adults with acute leukemia

Andromachi Scaradavou  1 , Claudio G Brunstein, Mary Eapen, Jennifer Le-Rademacher, Juliet N Barker, Nelson Chao, Corey Cutler, Colleen Delaney, Fangyu Kan, Luis Isola, Chatchada Karanes, Mary J Laughlin, John E Wagner, Elizabeth J Shpall
Affiliations
Clinical Trial

Double unit grafts successfully extend the application of umbilical cord blood transplantation in adults with acute leukemia

Andromachi Scaradavou et al. Blood. .

Abstract

Cell dose is a major limitation for umbilical cord blood (UCB) transplantation because units containing a minimum of 2.5 x 10(7) total nucleated cells (TNC)/kilogram patient body weight are frequently not available. The transplantation of 2 partially HLA-matched UCB units has been adopted as a simple approach for increasing the TNC.We sought to determine whether the relative safety and efficacy of this approach was comparable with a single UCB transplantation. Included are adults with acute leukemia who received transplants with 1 (n =106) or 2 (n =303) UCB units. All UCB units for single UCB transplantations contained TNC ≥ 2.5 x 10(7)/kg. For double UCB transplantations, the total TNC for units 1 and 2 were > 2.5 x 10(7)/kg but in approximately half of these transplantations, 1 of the 2 units contained < 2.5 x 10(7) TNC/kg. Adjusting for factors associated with outcomes, risks of neutrophil recovery (odds ratio 0.83, P =.59), transplantation-related mortality (hazard ratio [HR] 0.91, P= .63), relapse (HR 0.90, P= .64), and overall mortality (HR 0.93, P= .62) was similar after double UCB and adequate dose single UCB transplantations. These data support double UCB unit transplantation for acute leukemia when an adequately dosed single UCB unit is not available thereby extending access to nearly all patients.

Key points: Efficacy of transplanting adequately dosed 1- or 2-cord blood units.

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Figures

Figure 1
Figure 1
The cumulative incidence of TRM after double UCB and adequately dosed single UCB unit transplantation. The 2-year cumulative incidence of TRM after double UCB transplantations was 32% (95% CI, 26-37) compared with 38% (95% CI, 28-48) after single UCB transplantation.
Figure 2
Figure 2
The cumulative incidence of relapse after double UCB and adequately dosed single UCB unit transplantation. The 2-year cumulative incidence of relapse after double UCB transplantations was 36% (95% CI, 30-42) compared with 32% (95% CI, 22-43) after single UCB transplantation.
Figure 3
Figure 3
The adjusted probability of overall survival after double UCB and adequately dosed single UCB unit transplantation. The 2-year probability of overall survival after double UCB transplantations was 35% (95% CI, 29-42) compared with 33% (95% CI, 22-44), P = .66) after single UCB transplantation, adjusted for disease status at transplantation.
Figure 4
Figure 4
The adjusted probability of overall survival after double UCB transplantation (infused TNC of both units was < 2.5 × 107/kg [group 1], infused TNC of unit 1 was < 2.5 × 107/kg and unit 2, ≥ 2.5 × 107/kg [group 2] and infused TNC of both units was ≥ 2.5 × 107/kg [group 3]) and adequately dosed single UCB unit transplantation. The 2-year probabilities of overall survival were 37% (95% CI, 27-46), 36% (95% CI, 25-46), and 33% (95% CI, 21-46) after group 1, 2, and 3 double UCB transplantations, respectively, and 34% (95% CI, 24-45) after single UCB transplantation, adjusted for disease status at transplantation.
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References

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