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"No wash" albumin-dextran dilution for double-unit cord blood transplantation is safe with high rates of sustained donor engraftment.

Authors :
Dahi PB
Ponce DM
Devlin S
Evans KL
Lubin MN
Gonzales AM
Tonon J
Meagher R
Giralt S
Kernan NA
Scaradavou A
Barker JN
Source :
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2014 Apr; Vol. 20 (4), pp. 490-4. Date of Electronic Publication: 2013 Dec 18.
Publication Year :
2014

Abstract

Washing cord blood (CB) grafts involves product manipulation and may result in cell loss. We investigated double-unit CB transplantation (CBT) using red blood cell (RBC)-depleted units diluted with albumin-dextran in patients with hematologic malignancies. One-hundred thirty-six patients (median age, 43 years; range, 4 to 71; median weight, 69 kilograms (kg); range, 24 to 111) underwent transplantation with a 4/6 to 6/6 HLA-matched graft. Patients ≤ 20 kg were excluded, as they only received washed units. Units were diluted a median of 8 fold to a median volume of 200 mL/unit. The median infused total nucleated cell doses were 2.7 (larger unit) and 2.0 (smaller unit) x 10(7)/kg, respectively, and the median post-thaw recovery was 86%. Units were infused consecutively (median, 45 minutes/unit). While only 17 patients (13%) had no infusion reactions, reactions in the remaining 119 patients were almost exclusively mild-moderate (by CTCAE v4 criteria 12 grade 1, 43 grade 2, 63 grade 3) with only 1 patient (< 1%) having a severe (grade 4) reaction. Moreover, most were easily treated. Grade 2 to 3 hypertension was the most common in 101 (74%) patients. The cumulative incidence of sustained donor-derived neutrophil engraftment was high: 95% in myeloablative and 94% in nonmyeloablative CBT recipients. With appropriate supportive care, double-unit CBT with RBC-depleted grafts infused after albumin-dextran dilution is safe with high rates of engraftment in patients > 20 kg.<br /> (Copyright © 2014 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1523-6536
Volume :
20
Issue :
4
Database :
MEDLINE
Journal :
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
Publication Type :
Academic Journal
Accession number :
24361912
Full Text :
https://doi.org/10.1016/j.bbmt.2013.12.561