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Volume 339:1565-1577 November 26, 1998 Number 22 Next

	Full Text PDF Editorial by Parkman, R. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background A program for banking, characterizing, and distributing placental blood, also called umbilical-cord blood, for transplantation provided grafts for 562 patients between August 24, 1992, and January 30, 1998. We evaluated this experience.

Methods Placental blood was stored under liquid nitrogen and selected for specific patients on the basis of HLA type and leukocyte content. Patients were prepared for the transplantation of allogeneic hematopoietic cells in the placental blood and received prophylaxis against graft-versus-host disease (GVHD) according to routine procedures at each center.

Results Outcomes at 100 days after transplantation were known for all 562 patients, and outcomes at 1 year for 94 percent of eligible recipients. The cumulative rates of engraftment among the recipients, according to actuarial analysis, were 81 percent by day 42 for neutrophils (median time to engraftment, 28 days) and 85 percent by day 180 for platelets (median, day 90). The speed of myeloid engraftment was associated primarily with the leukocyte content of the graft, whereas transplantation-related events were associated with the patient's underlying disease and age, the number of leukocytes in the graft, the degree of HLA disparity, and the transplantation center. After engraftment, age, HLA disparity, and center were the primary predictors of outcome. Severe acute GVHD (grade III or IV) occurred in 23 percent of patients, and chronic GVHD occurred in 25 percent. The rate of relapse among recipients with leukemia was 9 percent within the first 100 days, 17 percent within 6 months, and 26 percent by 1 year. These rates were associated with the severity of GVHD, type of leukemia, and stage of the disease.

Conclusions Placental blood is a useful source of allogeneic hematopoietic stem cells for bone marrow reconstitution.

Source Information

From the F.H. Allen Laboratory of Immunogenetics (P.R., C.C., A.S., N.L.D., R.E.R.), the Laboratory of Hematopoietic Growth Factors (J.A., A.R.M.), and the Wolf Szmuness Laboratory of Epidemiology (P.E.T., C.E.S.), New York Blood Center, New York; the Pediatric Bone Marrow Transplant Unit, Duke University Medical Center, Durham, N.C. (J.K.); the Department of Obstetrics, Gynecology, and Reproductive Medicine, Mount Sinai Medical Center, New York (R.L.B.); and the Department of Obstetrics and Gynecology, Brooklyn Hospital Medical Center, Brooklyn, N.Y. (M.C.).

Address reprint requests to Dr. Rubinstein at the New York Blood Center, 310 E. 67th St., New York, NY 10021.

Full Text of this Article

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Cord-Blood Transplants
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Extract | Full Text  
N Engl J Med 1999; 340:1287-1288, Apr 22, 1999. Correspondence

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