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International Journal of Hematology

, Volume 83, Issue 1, pp 74–79 | Cite as

Reduced-Intensity Conditioning Followed by Unrelated Umbilical Cord Blood Transplantation for Advanced Hematologic Malignancies: Rapid Engraftment in Bone Marrow

  • Mahito Misawa
  • Masaya Okada
  • Toshiyuki Nakajima
  • Kaori Nomura
  • Takeshi Wakae
  • Akinari Toda
  • Hisayuki Itoi
  • Hiroyuki Takatsuka
  • Takeyoshi Itsukuma
  • Keisuke Nishioka
  • Hiroyasu Ogawa
  • Shunro Kai
  • Yoshihiro Fujimori
  • Hiroshi Hara
Article

Abstract

Reduced-intensity (RI) conditioning followed by cord blood transplantation (CBT) is a new treatment modality, but failure to engraft is a major concern. We describe 12 patients with advanced hematologic malignancies who underwent RI conditioning and CBT with a conditioning regimen consisting of 200 mg/m2 fludarabine (Flu), 50 mg/kg cyclophosphamide (CY), and 3 Gy total body irradiation (TBI). Cyclosporin A and/or methotrexate were used for graft-versus-host disease prophylaxis. Cord blood grafts were not mismatched for more than 2 serologically defined HLA alleles but were later found by high-resolution DNA typing to be mismatched for 2 to 4 alleles in most cases. Short tandem repeat analysis of bone marrow cells at day 14 showed complete donor chimerism in 6 of the patients and mixed chimerism in 5, indicating rapid engraftment in the bone marrow, whereas the remaining patient experienced graft rejection. Neutrophil recovery was achieved at a median of day 17 (range, days 11-24) in 10 of the 11 patients with marrow chimerism at day 14. Of these 10 patients, however, transplantation-related mortality within 100 days occurred in 4 patients who showed failed platelet recovery and a lack of durable engraftment. Overall survival and disease-free survival rates were 41.7% and 33.3%, respectively.These results show that CB mismatched at 2 to 4 HLA alleles and transplanted with the Flu/CY/3 Gy TBI regimen is able to engraft in the bone marrow as early as day 14.

Key words

Hematologic malignancy Cord blood transplantation Adult Reduced-intensity conditioning 

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Copyright information

© The Japanese Society of Hematology 2006

Authors and Affiliations

  • Mahito Misawa
    • 1
  • Masaya Okada
    • 1
  • Toshiyuki Nakajima
    • 1
  • Kaori Nomura
    • 1
  • Takeshi Wakae
    • 1
  • Akinari Toda
    • 1
  • Hisayuki Itoi
    • 1
  • Hiroyuki Takatsuka
    • 1
  • Takeyoshi Itsukuma
    • 1
  • Keisuke Nishioka
    • 1
  • Hiroyasu Ogawa
    • 1
  • Shunro Kai
    • 2
  • Yoshihiro Fujimori
    • 3
  • Hiroshi Hara
    • 4
  1. 1.Division of HematologyDepartment of Internal MedicineJapan
  2. 2.Division of Blood TransfusionJapan
  3. 3.Laboratory of Cell Transplantation, Institute for Advanced Medical SciencesHyogo College of MedicineNishinomiya, HyogoJapan
  4. 4.Uegahara Hospital, NishinomiyaJapan

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