PMID- 11400647
OWN - NLM
STAT- MEDLINE
DCOM- 20020321
LR  - 20041117
IS  - 0888-0018 (Print)
IS  - 0888-0018 (Linking)
VI  - 18
IP  - 4
DP  - 2001 Jun
TI  - Unrelated cord blood transplant experience by the pediatric blood and marrow 
      transplant consortium.
PG  - 235-45
AB  - Cord blood (CB) has emerged as a potential source of hematopoietic stem cells for 
      patients who are in need of hematopoietic stem cell transplant (HSCT). The 
      authors analyzed the Pediatric Blood and Marrow Transplant Consortium's (PBMTC) 
      data of consecutive unrelated CB transplants performed during the initial 2 years 
      of using placental blood grafts. From January 1995 to December 1996 PBMTC 
      performed a total of 44 unrelated CB transplant for a variety of diseases 
      consisting of acute leukemias (n = 29), congenital conditions (n = 9), and bone 
      marrow failure (n = 6). There were 15 females and 29 males with median age of 5 
      years (range 0.4-20.6 years) and median weight of 18.2 kg (range 6.3-70 kg). The 
      median volume of CB units was 80 mL (range 44.5-215 mL) and the median cell dose 
      given was 4.3 x 10(7)/kg of recipient weight (range 1.1-23 x 10(7)/kg). 
      Techniques used for human leukocyte antigen (HLA) matching were serologic typing 
      for class I HLA antigens and high-resolution molecular typing for HLA-DRB1 
      alleles. HLA disparities were as follows: 4 were 6/6 matches, 21 were 5/6, 15 
      were 4/6, and 4 were 3/6. Twenty-nine (66%) of CB units were DRB1 matched with 
      recipients. Conditioning regimens consisted of either total body irradiation 
      containing (n = 31) or chemotherapy only (n = 11) regimens. All but 3 patients 
      receive cyclosporine as part of graft vs. host disease (GvHD) prophylaxis in 
      combination with either methotrexate (MTX) or methylprednisolone (Pred). The 
      other 3 patients had FK506 and MTX for GvHD prophylaxis. Myeloid engraftment 
      (absolute neutrophil count > or = 500) occurred at a median of 21 days (range 
      10-43 days) and platelet > or = 50,000/mm3 was noted at a median of 44 days 
      (range 16-102 days). Eight patients died too early (< day + 28) for evaluation of 
      engraftment (5 for infection, 2 for multiorgan failure, 1 for toxic 
      epidermolysis). The probability of having grade II-IV acute GvHD for all patients 
      was 44 +/- 0.7%. The incidence of a GvHD is similar for 4/6 and 5/6 antigen when 
      DRB1 matched, at 47 and 52%, respectively. Chronic GvHD was noted in 28% of 
      patients surviving > 90 days. The Kaplan-Meier estimate of 4-year event-free 
      survival was 43%. A Cox model for analysis of factors associated with survival 
      was DRB1 matching, p = .001; cell dose, p = .009; and younger age, p = .03. In 
      conclusion, CB transplant offers a good alternative to bone marrow transplant 
      Although GvHD occurs, it is usually of low severity despite the high frequency of 
      multiple HLA antigen mismatches. It also appears that a 4/6 is as good as a 5/6 
      matched antigen CB unit when DRB1 matched especially in the pediatric setting.
FAU - Yu, L C
AU  - Yu LC
AD  - Children's Hospital/LSUHSC, 200 Henry Clay Avenue, New Orleans, LA 70118, USA. 
      lyu@lsuhsc.edu
FAU - Wall, D A
AU  - Wall DA
FAU - Sandler, E
AU  - Sandler E
FAU - Chan, K W
AU  - Chan KW
FAU - Grayson, G
AU  - Grayson G
FAU - Kletzel, M
AU  - Kletzel M
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Multicenter Study
PL  - England
TA  - Pediatr Hematol Oncol
JT  - Pediatric hematology and oncology
JID - 8700164
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Child
MH  - Child, Preschool
MH  - Databases, Factual
MH  - Female
MH  - *Fetal Blood
MH  - Graft Survival
MH  - Graft vs Host Disease/drug therapy/immunology/mortality
MH  - Hematopoietic Stem Cell Transplantation/methods/mortality/*statistics & numerical 
      data
MH  - Histocompatibility
MH  - Humans
MH  - Infant
MH  - Male
MH  - Retrospective Studies
MH  - Survival Analysis
MH  - Transplantation, Homologous
EDAT- 2001/06/13 10:00
MHDA- 2002/03/22 10:01
CRDT- 2001/06/13 10:00
PHST- 2001/06/13 10:00 [pubmed]
PHST- 2002/03/22 10:01 [medline]
PHST- 2001/06/13 10:00 [entrez]
AID - 9HATDBYVNJV9MKH8 [pii]
AID - 10.1080/088800101750238531 [doi]
PST - ppublish
SO  - Pediatr Hematol Oncol. 2001 Jun;18(4):235-45. doi: 10.1080/088800101750238531.