摘要
Background Wide application of umbilical cord blood transplantation （UCBT） in adult patients is limited by low cell-dose available in one umbilical cord blood （UCB） unit. The aim of this study was to investigate the safety and long-term outcomes of UCBT from unrelated donors in adult and adolescent patients with leukemia. Methods Thirteen patients with leukemia received double-unit UCBT with human leukocyte antigen （HLA） mismatched at 0-2 loci. We analyzed the engraftment, graft-versus-host disease （GVHD） and survival. Results Twelve evaluable patients （92.3%） had neutrophil and platelet engraftment at a median of 21 days （range, 16-38 days） and 34 days （range, 25-51 days）, respectively. At day 30, engraftment was derived from one donor in 8 patients （66.7%, 95% Cl 40.0%-93.4%）, and from both donors in 4 patients （33.3%, 95% CI 6.7%-60.0%） with 1 unit predominated. Unit with larger nucleated cell （NC） dose would predominate in engraftment （P=-0.039）, whereas CD34~ cell dose or HLA-match failed to demonstrate any relationship with unit predominance. Only one patient developed grade II acute graft-versus-host disease （aGVHD）. Chronic GVHD （cGVHD） was observed in 2 of 11 patients who survived more than 100 days, and both were limited. The median follow-up after transplantation for the 13 patients was 45 months （range 1.5-121.0 months） and 72 months （range 41.0-121.0 months） for the 8 alive and with full donor chimerism. The 5-year cumulative disease free survival （DFS） was （61.5±13.5）%. Of the 13 patients, 5 patients died in 1 year and 1-year transplantation related mortality （TRM） was 23.1% （95% Cl 0.2%-46.0%）. Conclusion Double-unit UCBT from unrelated donors with HLA-mismatched at 0-2 loci may overcome the cell-dose barrier and be feasible for adults and adolescents with leukemia.
Background Wide application of umbilical cord blood transplantation （UCBT） in adult patients is limited by low cell-dose available in one umbilical cord blood （UCB） unit. The aim of this study was to investigate the safety and long-term outcomes of UCBT from unrelated donors in adult and adolescent patients with leukemia. Methods Thirteen patients with leukemia received double-unit UCBT with human leukocyte antigen （HLA） mismatched at 0-2 loci. We analyzed the engraftment, graft-versus-host disease （GVHD） and survival. Results Twelve evaluable patients （92.3%） had neutrophil and platelet engraftment at a median of 21 days （range, 16-38 days） and 34 days （range, 25-51 days）, respectively. At day 30, engraftment was derived from one donor in 8 patients （66.7%, 95% Cl 40.0%-93.4%）, and from both donors in 4 patients （33.3%, 95% CI 6.7%-60.0%） with 1 unit predominated. Unit with larger nucleated cell （NC） dose would predominate in engraftment （P=-0.039）, whereas CD34~ cell dose or HLA-match failed to demonstrate any relationship with unit predominance. Only one patient developed grade II acute graft-versus-host disease （aGVHD）. Chronic GVHD （cGVHD） was observed in 2 of 11 patients who survived more than 100 days, and both were limited. The median follow-up after transplantation for the 13 patients was 45 months （range 1.5-121.0 months） and 72 months （range 41.0-121.0 months） for the 8 alive and with full donor chimerism. The 5-year cumulative disease free survival （DFS） was （61.5±13.5）%. Of the 13 patients, 5 patients died in 1 year and 1-year transplantation related mortality （TRM） was 23.1% （95% Cl 0.2%-46.0%）. Conclusion Double-unit UCBT from unrelated donors with HLA-mismatched at 0-2 loci may overcome the cell-dose barrier and be feasible for adults and adolescents with leukemia.
