Outcomes among 562 Recipients of Placental-Blood Transplants from Unrelated Donors
Pablo Rubinstein, M.D., Carmelita Carrier, Ph.D., Andromachi Scaradavou, M.D., Joanne Kurtzberg, M.D., John Adamson, M.D., Anna Ritá Migliaccio, Ph.D., Richard L. Berkowitz, M.D., M.P.H., Michael Cabbad, M.D., N. Ludy Dobrila, Ph.D., Patricia E. Taylor, Ph.D., Richard E. Rosenfield, M.D., and Cladd E. Stevens, M.D., M.P.H.
Background A program for banking, characterizing, and distributingplacental blood, also called umbilical-cord blood, for transplantationprovided grafts for 562 patients between August 24, 1992, andJanuary 30, 1998. We evaluated this experience.
Methods Placental blood was stored under liquid nitrogen andselected for specific patients on the basis of HLA type andleukocyte content. Patients were prepared for the transplantationof allogeneic hematopoietic cells in the placental blood andreceived prophylaxis against graft-versus-host disease (GVHD)according to routine procedures at each center.
Results Outcomes at 100 days after transplantation were knownfor all 562 patients, and outcomes at 1 year for 94 percentof eligible recipients. The cumulative rates of engraftmentamong the recipients, according to actuarial analysis, were81 percent by day 42 for neutrophils (median time to engraftment,28 days) and 85 percent by day 180 for platelets (median, day90). The speed of myeloid engraftment was associated primarilywith the leukocyte content of the graft, whereas transplantation-relatedevents were associated with the patient's underlying diseaseand age, the number of leukocytes in the graft, the degree ofHLA disparity, and the transplantation center. After engraftment,age, HLA disparity, and center were the primary predictors ofoutcome. Severe acute GVHD (grade III or IV) occurred in 23percent of patients, and chronic GVHD occurred in 25 percent.The rate of relapse among recipients with leukemia was 9 percentwithin the first 100 days, 17 percent within 6 months, and 26percent by 1 year. These rates were associated with the severityof GVHD, type of leukemia, and stage of the disease.
Conclusions Placental blood is a useful source of allogeneichematopoietic 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.
Cord-Blood Transplants
Fernández M. N., Millán I., Gluckman E., Rubinstein P., Stevens C. E., Kurtzberg J.
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N Engl J Med 1999;
340:1287-1288, Apr 22, 1999.
Correspondence
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