Synapse - A novel reduced-intensity conditioning regimen induces a high incidence of sustained donor-derived neutrophil and platelet engraftment after double-unit cord blood transplantation

A novel reduced-intensity conditioning regimen induces a high incidence of sustained donor-derived neutrophil and platelet engraftment after double-unit cord blood transplantation Journal Article

Authors:	Ponce, D. M.; Sauter, C.; Devlin, S.; Lubin, M.; Gonzales, A. M.; Kernan, N. A.; Scaradavou, A.; Giralt, S.; Goldberg, J. D.; Koehne, G.; Perales, M. A.; Young, J. W.; Castro-Malaspina, H.; Jakubowski, A.; Papadopoulos, E. B.; Barker, J. N.
Article Title:	A novel reduced-intensity conditioning regimen induces a high incidence of sustained donor-derived neutrophil and platelet engraftment after double-unit cord blood transplantation
Abstract:	A preparative regimen of reduced intensity that can reliably engraft cord blood (CB) and can be used as an alternative to either high-dose myeloablative or nonmyeloablative conditioning is needed. We evaluated double-unit CB transplantation in 30 patients (median age, 56 years; range, 18 to 69) with acute leukemia or myelodysplasia using a regimen of cyclophosphamide 50 mg/kg, fludarabine 150 mg/m2, thiotepa 10 mg/kg, and 400 cGy total body irradiation with cyclosporine-A/mycophenolate mofetil immunosuppression. Ninety-seven percent of patients engrafted at a median of 26 days (range, 13 to 43), and 93% of patients had recovered platelets by day 180. Grades II to IV acute graft-versus-host disease (GVHD) incidence was 67% at day 180, and chronic GVHD was 10% at 1 year. Transplant-related mortality was 20% at day 180, and relapse was 11% at 2 years. Overall, 2-year disease-free survival (DFS) was 60% at 2 years. A hierarchy in DFS was seen according to the Sorror comorbidity score: 11 patients (median age, 55 years) with a score of 1 had a 2-year DFS of 82% compared with 62% in 9 patients (median age, 51 years) with a score of 2 to 3 and 40% in 11 patients (median age, 58 years) with a score of 4 to 5 (P = .13). This reduced-intensity regimen combined with double-unit CB transplantation reliably facilitates sustained donor engraftment without antithymocyte globulin. Although other approaches are needed in patients with high comorbidity scores, this regimen is highly effective in patients ≥50 years old who are otherwise reasonably fit. It also represents a promising alternative to high-dose conditioning in younger patients. © 2013 American Society for Blood and Marrow Transplantation.
Keywords:	cord blood; acute leukemia; allogeneic transplant; comorbidity score
Journal Title:	Biology of Blood and Marrow Transplantation
Volume:	19
Issue:	5
ISSN:	1083-8791
Publisher:	Elsevier Inc.
Date Published:	2013-05-01
Start Page:	799
End Page:	803
Language:	English
PROVIDER:	scopus
PUBMED:	23416850
DOI:	10.1016/j.bbmt.2013.02.007
PMCID:	PMC3673764
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84876329212&partnerID=40&md5=2a5f66c859ccf116719f7db56379e694
Notes:	--- - "Export Date: 1 May 2013" - "CODEN: BBMTF" - ":doi 10.1016/j.bbmt.2013.02.007" - "Source: Scopus"