Related Experiment Videos
Cord blood banking and transplant in Europe. Eurocord
E Gluckman1, V Rocha, C Chastang
1Hôpital St Louis, Paris, France.
Insights
Cord blood transplants (CBT) offer a viable treatment for hematological disorders. This study analyzed 143 CBT cases, finding related donor transplants had higher survival rates and lower graft-versus-host disease (GVHD) incidence, especially with HLA matching and negative CMV status.
Area of Science:
- Hematology
- Immunology
- Transplantation Medicine
Background:
- Cord blood transplants (CBT) are increasingly utilized for hematological disorders.
- The EUROCORD registry collects data on CBT outcomes.
- Previous studies highlighted the need for comprehensive analysis of prognostic factors.
Purpose of the Study:
- To analyze the outcomes of cord blood transplants (CBT) including survival, engraftment, and graft-versus-host disease (GVHD).
- To identify prognostic factors influencing CBT success in patients with hematological disorders.
- To compare outcomes between related and unrelated donor CBT.
Main Methods:
- Analysis of 143 CBT cases from 1988-1996 collected via EUROCORD questionnaires.
- Separate analysis of outcomes for related (78 patients) and unrelated (65 patients) donor transplants.
- Evaluation of survival, engraftment, and GVHD incidence based on patient and donor factors.
Main Results:
- One-year survival was 63% for related donor CBT and 29% for unrelated donor CBT.
- Favorable prognostic factors for related transplants included recipient age, weight, HLA identity, and negative CMV serology.
- Negative recipient CMV serology was crucial for survival and GVHD prediction in unrelated transplants.
Conclusions:
- Cord blood is a feasible source of hematopoietic stem cells for hematological disorders.
- Related donor CBT demonstrates better outcomes than unrelated donor CBT.
- Recipient CMV serology is a critical factor influencing CBT success and GVHD.
Abstract:
Cord blood banks have increased the use of cord blood transplants (CBT) for patients with hematological disorders. EUROCORD has established a registry for providing information on the outcome of CBT. Questionnaires were sent to all EUROCORD members to collect information on patients transplanted from 1988 to 1996. One hundred and forty-three CBT, performed in 45 centers, were analyzed for survival, engraftment and graft-versus-host disease (GVHD). Results in recipients of related and unrelated transplants were analyzed separately. In 78 patients who received CB from a related donor, 1-year survival was 63 +/- 6%. Age, weight, HLA identity and negative cytomegalovirus (CMV) serology in the recipient were significant favorable prognostic factors. Among these 78 patients, the incidence of grade > or = II GVHD was 9% in HLA matched CBT and 50% in mismatched CBT. Neutrophil engraftment was associated with age < 6 years (P = 0.02), weight < 20 kg (P = 0.02). It was 73% in patients receiving < 3.7 x 10(7) nucleated cells (NC) infused/kg and 85% in patients receiving more (P = 0.06). Among 65 patients, who received CB from an unrelated donor, 1-year survival was 29 +/- 7%. Negative recipient CMV serology was associated with improved survival (P = 0.01). Acute GVHD > or = II was observed in 40% of these patients. Negative recipient CMV serology was the most important factor for predicting GVHD (P = 0.04). Neutrophil recovery was 76% in patients receiving < 3.7 x 10(7) NC/kg and 94% in patients receiving more (P = 0.008). Cord blood is a feasible alternative source of hematopoietic stem cells for treating patients with various hematological disorders.