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Previous Volume 344:1815-1822 June 14, 2001 Number 24 Next

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

ABSTRACT

Background Umbilical-cord blood from unrelated donors who are not HLA-identical with the recipients can restore hematopoiesis after myeloablative therapy in children. We studied the use of transplantation of umbilical-cord blood to restore hematopoiesis in adults.

Methods Sixty-eight adults with life-threatening hematologic disorders received intensive chemotherapy or total-body irradiation and then transplants of HLA-mismatched umbilical-cord blood. We evaluated the outcomes in terms of hematologic reconstitution, the occurrence of acute and chronic graft-versus-host disease (GVHD), relapses, and event-free survival.

Results Of the 68 patients, 48 (71 percent) received grafts of umbilical-cord blood that were mismatched for two or more HLA antigens. Of the 60 patients who survived 28 days or more after transplantation, 55 had neutrophil engraftment at a median of 27 days (range, 13 to 59). The estimated probability of neutrophil recovery in the 68 patients was 0.90 (95 percent confidence interval, 0.85 to 1.0). The presence of a relatively high number of nucleated cells in the umbilical-cord blood before it was frozen was associated with faster recovery of neutrophils. Severe acute GVHD (of grade III or IV) occurred in 11 of 55 patients who could be evaluated within the first 100 days after transplantation. Chronic GVHD developed in 12 of 33 patients who survived for more than 100 days after transplantation. The median follow-up for survivors was 22 months (range, 11 to 51). Of the 68 patients, 19 were alive and 18 of these (26 percent) were disease-free 40 months after transplantation. The presence of a high number of CD34+ cells in the graft was associated with improved event-free survival (P=0.05).

Conclusions Umbilical-cord blood from unrelated donors can restore hematopoiesis in adults who receive myeloablative therapy and is associated with acceptable rates of severe acute and chronic GVHD.

Source Information

From the Department of Medicine, Ireland Comprehensive Cancer Center at University Hospitals of Cleveland and Case Western Reserve University, Cleveland (M.J.L., O.N.K., S.L.G., H.M.L.); the Departments of Medicine (J.B.) and Pediatrics (J.E.W.), University of Minnesota, Minneapolis; the Departments of Medicine and Pediatrics, Roswell Park Cancer Institute, Buffalo, N.Y. (B.B.); the Departments of Medicine (D.A.R.) and Pediatrics (J.K.), Duke University Medical Center, Durham, N.C.; the Department of Pediatrics, Columbia University and Columbia–Presbyterian Medical Center of New York, Babies and Children's Hospital, New York (M.C.); and the Lindsley F. Kimball Research Institute, Placental Blood Program, New York Blood Center, New York (C.E.S., P.R.).

Address reprint requests to Dr. Laughlin at Case Western Reserve University, University Hospitals of Cleveland Ireland Comprehensive Cancer Center, 11100 Euclid Ave., Wearn 433, Cleveland, OH 44106-5065, or at mjl13{at}po.cwru.edu.

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