Engraftment kinetics after transplantation of double unit cord blood grafts combined with haplo-identical CD34+ cells without antithymocyte globulin Journal Article


Authors: Politikos, I.; Devlin, S. M.; Arcila, M. E.; Barone, J. C.; Maloy, M. A.; Naputo, K. A.; Ruiz, J. D.; Mazis, C. M.; Scaradavou, A.; Avecilla, S. T.; Dahi, P. B.; Giralt, S. A.; Hsu, K. C.; Jakubowski, A. A.; Papadopoulos, E. B.; Perales, M. A.; Sauter, C. S.; Tamari, R.; Ponce, D. M.; O’Reilly, R. J.; Barker, J. N.
Article Title: Engraftment kinetics after transplantation of double unit cord blood grafts combined with haplo-identical CD34+ cells without antithymocyte globulin
Abstract: Double unit cord blood (dCB) transplantation (dCBT) is associated with high engraftment rates but delayed myeloid recovery. We investigated adding haplo-identical CD34+ cells to dCB grafts to facilitate early haplo-identical donor-derived neutrophil recovery (optimal bridging) prior to CB engraftment. Seventy-eight adults underwent myeloablation with cyclosporine-A/mycophenolate mofetil immunoprophylaxis (no antithymocyte globulin, ATG). CB units (median CD34+ dose 1.1 × 105/kg/unit) had a median 5/8 unit-recipient human leukocyte antigen (HLA)-match. Haplo-identical grafts had a median CD34+ dose of 5.2 × 106/kg. Of 77 evaluable patients, 75 had sustained CB engraftment that was mediated by a dominant unit and heralded by dominant unit-derived T cells. Optimal haplo-identical donor-derived myeloid bridging was observed in 34/77 (44%) patients (median recovery 12 days). Other engrafting patients had transient bridging with second nadir preceding CB engraftment (20/77 (26%), median first recovery 12 and second 26.5 days) or no bridge (21/77 (27%), median recovery 25 days). The 2 (3%) remaining patients had graft failure. Higher haplo-CD34+ dose and better dominant unit-haplo-CD34+ HLA-match significantly improved the likelihood of optimal bridging. Optimally bridged patients were discharged earlier (median 28 versus 36 days). ATG-free haplo-dCBT can speed neutrophil recovery but successful bridging is not guaranteed due to rapid haplo-identical graft rejection. © 2020, The Author(s), under exclusive licence to Springer Nature Limited.
Journal Title: Leukemia
Volume: 35
Issue: 3
ISSN: 0887-6924
Publisher: Nature Publishing Group  
Date Published: 2021-03-01
Start Page: 850
End Page: 862
Language: English
DOI: 10.1038/s41375-020-0922-x
PUBMED: 32555371
PROVIDER: scopus
PMCID: PMC7746597
DOI/URL:
Notes: Article -- Export Date: 1 April 2021 -- Source: Scopus
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Citation Impact
MSK Authors
  1. Sergio Andres Giralt
    743 Giralt
  2. Craig Steven Sauter
    256 Sauter
  3. Doris Ponce
    182 Ponce
  4. Miguel-Angel Perales
    570 Perales
  5. Katharine C Hsu
    163 Hsu
  6. Juliet N Barker
    294 Barker
  7. Maria Eugenia Arcila
    517 Arcila
  8. Richard O'Reilly
    656 O'Reilly
  9. Molly Anna Maloy
    242 Maloy
  10. Sean McCarthy Devlin
    434 Devlin
  11. Parastoo Bahrami Dahi
    178 Dahi
  12. Roni Tamari
    132 Tamari
  13. Christopher M Mazis
    20 Mazis
  14. Kristine Anne Naputo
    21 Naputo
  15. Josel Dumo Ruiz
    31 Ruiz
  16. Jonathan C. Barone
    1 Barone