Blood Journal
Leading the way in experimental and clinical research in hematology

Double unit grafts successfully extend the application of umbilical cord blood transplantation in adults with acute leukemia

  1. Andromachi Scaradavou1,
  2. Claudio G. Brunstein2,
  3. Mary Eapen3,
  4. Jennifer Le-Rademacher4,
  5. Juliet N. Barker5,
  6. Nelson Chao6,
  7. Corey Cutler7,
  8. Colleen Delaney8,
  9. Fangyu Kan9,
  10. Luis Isola10,
  11. Chatchada Karanes11,
  12. Mary J. Laughlin12,
  13. John E. Wagner2, and
  14. Elizabeth J. Shpall13,*
  1. 1 New York Blood Center, New York, NY, United States;
  2. 2 University of Minnesota, Minneapolis, MN, United States;
  3. 3 Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States;
  4. 4 Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, United States;
  5. 5 Memorial Sloan-Kettering Cancer Center, New York, NY, United States;
  6. 6 Duke University Medical Center, Durham, NC, United States;
  7. 7 Dana Farber Cancer Institute, Boston, MA, United States;
  8. 8 Fred Hutchinson Cancer Research Center, Seattle, WA, United States;
  9. 9 Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI, United States;
  10. 10 Mount Sinai Medical Center, New York, NY, United States;
  11. 11 City of Hope, Duarte, CA, United States;
  12. 12 University of Virginia Health Systems, Charlottesville, VA, United States;
  13. 13 MD Anderson Cancer Center, Houston, TX, United States
  1. * Corresponding author; email: eshpall{at}mdanderson.org

Abstract

Cell dose is a major limitation for umbilical cord blood (UCB) transplantation since units containing a minimum of 2.5 x 107 total nucleated cells (TNC)/ kilogram patient body weight are frequently not available. The transplantation of two partially HLA-matched UCB units has been adopted as a simple approach for increasing the TNC. We sought to determine whether the relative safety and efficacy of this approach was comparable to a single UCB transplant. Included are adults with acute leukemia transplanted with one (n=106) or two UCB units (n=303). All UCB units for single UCB transplants contained TNC ≥2.5 x 107/kg. For double UCB transplants, the total TNC for units 1 and 2 were greater than 2.5 x 107/kg but in about half of these transplants, one of the two units contained <2.5 x 107 TNC/kg. Adjusting for factors associated with outcomes, risks of neutrophil recovery (OR 0.83, p=0.59), transplant-related mortality (HR 0.91, p=0.63), relapse (HR 0.90, p=0.64) and overall mortality (HR 0.93, p=0.62) was similar after double UCB and adequate dose single UCB transplants. These data support double UCB unit transplantation for acute leukemia when an adequately dosed single UCB unit is not available thereby extending access to nearly all patients.

  • Submitted August 8, 2012.
  • Accepted November 19, 2012.