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Long-term results of placental blood allografting using reduced-intensity conditioning: multicenter experience in a
Guillermo J Ruiz-Delgado1, Consuelo Mancias-Guerra, Julio Macias-Gallardo
1Centro de Hematologia y Medicina Interna de Puebla, Puebla, Mexico.
Insights
Hematopoietic stem cell transplants using placental blood (PLB) showed a 32% survival rate at 36 months. Improving cord blood unit selection is key to enhancing engraftment success in these stem cell therapies.
Area of Science:
- Hematology
- Transplantation Medicine
- Immunology
Background:
- Placental blood (PLB) hematopoietic stem cell transplantation is increasingly used.
- The optimal conditioning regimen for PLB transplantation remains undefined.
Purpose of the Study:
- To evaluate the outcomes of allogeneic PLB hematopoietic stem cell transplantation using a reduced-intensity conditioning regimen.
- To assess engraftment, survival, and graft-versus-host disease (GVHD) in patients undergoing PLB transplantation.
Main Methods:
- A total of 66 patients (pediatric and adult) received allogeneic PLB cells with reduced-intensity conditioning.
- Patients were treated for malignant or non-malignant conditions.
- Follow-up ranged from 0.5 to 66 months.
Main Results:
- Median time to granulocyte recovery was 19 days; platelet recovery was 23 days.
- Thirty-eight patients failed to engraft.
- Median overall survival was 22 months, with 36-month survival at 32%, significantly higher for 6/6 matched grafts (45%).
- Cumulative incidence of grade II-IV acute GVHD was 33%; grade III-IV acute GVHD was 10% in engrafted patients.
Conclusions:
- The low engraftment rate necessitates improved cord blood unit selection.
- Further research is required to determine if non-myeloablative conditioning is superior to conventional conditioning for PLB transplantation.
Background:
Placental blood (PLB) hematopoietic stem cell transplantation has recently been explored in an increasing number of patients; the best conditioning regimen has not been established.
Material And Methods:
In an eight-year period, 66 consecutive patients, both children and adults (40 males and 26 females), were grafted with allogeneic placental blood cells using a reduced-intensity conditioning regimen: 23 patients were grafted because of a non-malignant condition and 43 patients for a malignant disease. The median age was 7 years (range 5 months to 72 years).
Results:
Median time to recover >0.5×10(9)/l granulocytes was 19 days, whereas median time to recover >20×10(9)/l platelets was 23 days. Thirty-eight individuals failed to engraft and they either recovered endogenous hematopoiesis or died. Patients have been followed for periods ranging from 0.5 to 66 months, median 9 months. The median overall post-transplant survival (OS) was 22 months and the 36-month OS was 32%; it was significantly better for individuals grafted with 6/6 matched cords (45%). The cumulative incidences of grade II-IV acute graft-versus-host disease (GVHD) and grade III-IV acute GVHD for the patients who engrafted were 33 and 10%, respectively.
Discussion:
The low engraftment rate should be improved by selecting better cord blood units; additional studies are needed to define if non-myeloablative conditioning is preferable over conventional conditioning.
