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Pre-transplant prognostic factors for patients with high-risk leukemia undergoing an unrelated cord blood transplantation
- Source :
- Bone marrow transplantation. 33(11)
- Publication Year :
- 2004
-
Abstract
- From July 1995 to December 2001, 42 patients with leukemia aged 1-42 years underwent cord blood transplant (CBT) from unrelated, < or = 2 antigen HLA mismatched donors. In all, 26 patients were in < or = 2nd complete remission and 16 in more advanced phase. Conditioning regimens, graft-versus-host disease (GVHD) prophylaxis and supportive policy were uniform for all patients. The cumulative incidence of engraftment was 90% (95% CI: 0.78-0.91). The cumulative incidence of III-IV grade acute- and chronic-GVHD was 9% (95% CI: 0.04-0.24) and 35% (95% CI: 0.21-0.60), respectively. The 4-year cumulative incidence of transplant-related mortality (TRM) and relapse was 28% (95% CI: 0.17-0.47) and 25% (95% CI: 0.14-0.45), respectively. The 4-year overall survival (OS), leukemia-free survival (LFS) and event-free survival (EFS) were 45% (95% CI: 0.27-0.63), 47% (95% CI: 0.30-0.64) and 46% (95% CI: 0.30-0.62), respectively. In multivariate analysis, the most important factor affecting outcomes was the CFU-GM dose, associated with CMV serology (P=0.003 and 0.04, respectively) in influencing OS and with patient sex (P=0.008 and 0.03, respectively) in influencing LFS. Finally, CFU-GM dose was the only factor that affected EFS significantly (P=0.02). In conclusion, the infused cell dose expressed as in vitro progenitor cell growth is highly predictive of outcomes after an unrelated CBT and should be considered the main parameter in selecting cord blood units for transplant.
- Subjects :
- Adult
Male
medicine.medical_specialty
Adolescent
Graft vs Host Disease
Cell Count
Gastroenterology
Umbilical cord
Serology
Risk Factors
Internal medicine
medicine
Humans
Cumulative incidence
Longitudinal Studies
Risk factor
Progenitor cell
Preschool
Child
Survival analysis
Transplantation
Leukemia
business.industry
Graft Survival
Infant
Hematology
medicine.disease
Hematopoietic Stem Cells
Prognosis
Survival Analysis
Cord Blood Stem Cell Transplantation
Tissue Donors
Child, Preschool
Treatment Outcome
Female
Surgery
medicine.anatomical_structure
Cord blood
business
cord blood transplant
leukemia
prognostic factors
unrelated hsc transplant
Settore MED/15 - Malattie del Sangue
Subjects
Details
- ISSN :
- 02683369
- Volume :
- 33
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- Bone marrow transplantation
- Accession number :
- edsair.doi.dedup.....845e1572e61a941ded9430d36e224472