WESTPORT, CT (Reuters Health) Nov 13, 2001 — When no suitable bone marrow (BM) donor is available, cord blood transplantation from an unrelated donor (UD-CBT) appears to be a "reasonable alternative" for young adults with hematologic malignancies.

Dr. Miguel A. Sanz, from Hospital Universitario La Fe in Valencia, Spain, and colleagues assessed the outcomes of 22 patients, 18 to 46 years of age, with hematologic malignancies who underwent UD-CBT.

Pre-transplant conditioning was achieved with thiotepa, busulfan, cyclophosphamide, and antithymocyte globulin in 21 patients and with thiotepa, fludarabine, and antithymocyte globulin in one patient. Cyclosporine and prednisone was used for graft-versus-host disease (GVHD) prophylaxis. The HLA match, in all cases, was at least four of 6. The median number of nucleated cells infused was approximately 17 million cells/kg.

Myeloid engraftment was achieved in all 20 patients who survived more than 30 days after transplantation, the authors note. However, one patient who received the lowest cell dose did experience secondary graft failure.

Seven patients developed acute GVHD of grade 2 or higher, the researchers state. Nine of 10 at-risk patients developed chronic GVHD, with four experiencing extensive disease.

Disease-free survival 1 year after transplantation was 53%. However, when the analysis was limited to patients 30 years of age or younger the disease-free survival was 73%, the investigators point out in the October 15th issue of Blood.

The current findings indicate that UD-CBT can produce sustained myeloid engraftment in most adult patients with hematologic malignancies. The findings "also suggest that UD-CBT can result in long-term disease-free survival in many of these patients, particularly in younger patients who receive transplants in earlier stages of their diseases," Dr. Sanz's team states.

Blood 2001;98:2332-2338.

Source: Reuters

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