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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