A "no-wash" albumin-dextran dilution strategy for cord blood unit thaw: High rate of engraftment and a low incidence of serious infusion reactions Journal Article
| Authors: | Barker, J. N.; Abboud, M.; Rice, R. D.; Hawke, R.; Schaible, A.; Heller, G.; La Russa, V.; Scaradavou, A. |
| Article Title: | A "no-wash" albumin-dextran dilution strategy for cord blood unit thaw: High rate of engraftment and a low incidence of serious infusion reactions |
| Abstract: | Preparation of cord blood (CB) units for infusion by albumin-dextran dilution without centrifugation may be advantageous for adult patients to minimize cell loss and, unlike a bedside thaw, is still conducted in the controlled laboratory environment. Therefore, we studied CB transplantation (CBT) using this technique in 54 consecutive CBT recipients >20 kg. Patients (median age=42 years [range: 7-66 years]; median weight=71 kg [range: 24-109]) were transplanted for high-risk hematologic malignancies with myeloablative (n=35) or nonmyeloablative (n=19) conditioning and 4-6/6 human leukocyte antigen (HLA)-matched double-unit grafts. One hundred seven units were thawed with dilution, whereas 1 red blood cell (RBC)-replete unit was washed. A 5:1 dextran 40%/25% albumin solution was used. RBC-depleted units (n=104) were diluted ≥5.5-fold (median final volume 200 mL [range: 200-500]), whereas RBC-replete units (n=3) were diluted ≥4-fold (median final volume 400 mL [range: 400-535]). Total nucleated cell (TNC) recovery was 86%; the median infused TNC dose was 2.17×10<sup>7</sup>/kg/unit. Although 35 patients (65%) had a total of 45 infusion reactions (6 nausea, 31 hypertension, 3 pain, 1 rigors/fever, 2 transient hypoxia, 2 renal impairment) requiring additional therapy, there were no infusion-related serious adverse events, and reactions were not related to dimethyl sulfoxide (DMSO) dose/kg. Cumulative incidence of sustained donor engraftment was 94% (95% cumulative incidence [CI]: 87-100) with neutrophil recovery occurring at a median of 25 days (range: 13-43) in myeloablative and 10 days (range: 7-36) in nonmyeloablative recipients. CB thaw with albumin-dextran dilution reduces unit manipulation, and minimizes cell loss, speeds time to infusion, is associated with a tolerable infusion reaction profile, and a high rate of sustained engraftment in CBT recipients ≥20 kg. © 2009. |
| Keywords: | adolescent; adult; child; controlled study; aged; middle aged; young adult; major clinical study; overall survival; fludarabine; hypertension; disease free survival; prospective studies; neutrophil count; nausea; lorazepam; cyclophosphamide; furosemide; melphalan; bradycardia; creatinine blood level; kidney failure; thiotepa; hodgkin disease; abdominal pain; fever; hypoxia; cord blood; cryopreservation; hematopoeitic stem cell transplantation; albumin; dextran; dimethyl sulfoxide; hydralazine; narcotic analgesic agent; pethidine; acute graft versus host disease; acute leukemia; blood transfusion reaction; chronic graft versus host disease; cord blood stem cell transplantation; disease severity; engraftment; graft failure; hematologic malignancy; hemodilution; hla matching; myeloablative conditioning; myelodysplastic syndrome; nonhodgkin lymphoma; nonmyeloablative conditioning; rigor; thawing; thorax pain; whole body radiation; albumins; blood preservation; dextrans; fetal blood |
| Journal Title: | Biology of Blood and Marrow Transplantation |
| Volume: | 15 |
| Issue: | 12 |
| ISSN: | 1083-8791 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2009-12-01 |
| Start Page: | 1596 |
| End Page: | 1602 |
| Language: | English |
| DOI: | 10.1016/j.bbmt.2009.08.009 |
| PUBMED: | 19896084 |
| PROVIDER: | scopus |
| PMCID: | PMC3105472 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 5" - "Export Date: 30 November 2010" - "CODEN: BBMTF" - "Source: Scopus" |
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