PMID- 15528148
OWN - NLM
STAT- MEDLINE
DCOM- 20050406
LR  - 20041105
IS  - 1079-9796 (Print)
IS  - 1079-9796 (Linking)
VI  - 33
IP  - 3
DP  - 2004 Nov-Dec
TI  - Hematopoietic stem cell transplantation from alternative sources in adults with 
      high-risk acute leukemia.
PG  - 294-302
AB  - Since 75% of patients with high-risk acute leukemia do not have a human leukocyte 
      antigen (HLA)-identical sibling, alternative sources for hematopoietic stem cell 
      transplantation (HSCT) are matched unrelated donors (MUD), unrelated umbilical 
      cord blood (UD-UCB) and one HLA haplotype mismatched family members 
      (haploidentical). The chance of finding a suitable donor in the international 
      voluntary donor registries is limited by frequency of the HLA phenotype and the 
      time required to identify the right donor from a potential panel, to establish 
      eligibility and to harvest the cells. In adult MUD recipients, event-free 
      survival ranges up to 50% and refers only to patients who undergo transplant, 
      without taking into account those who do not find a donor. Umbilical cord blood 
      offers the advantages of easy procurement, the absence of risks to donors, the 
      reduced risk of transmitting infections, immediate availability of cryopreserved 
      samples and acceptance of mismatches at two of the six antigens. Although UD-UCB 
      transplantation is a viable option for children, it is seldom considered for 
      adults. The great divergency between body weight and the number of hematopoietic 
      cells in a standard cord blood unit, particularly if associated with a 
      two-antigen mismatch, increases the risk of graft failure and delays 
      hematopoietic reconstitution. Work on full-haplotype mismatched transplants has 
      been proceeding for over 20 years. Originally, outcome in leukemia patients was 
      disappointing because of high incidence of severe graft-vs.-host disease in 
      T-replete transplants and high rejection rates in T-cell-depleted transplants. 
      The breakthrough came with the use of a megadose of T-cell-depleted progenitor 
      cells after a high-intensity conditioning regimen. Treating end-stage patients 
      inevitably confounded clinical outcome in the early pilot studies. Today, 
      high-risk acute leukemia patients are treated at less advanced stages of disease, 
      receive a reasonably well tolerated conditioning regimen, and benefit from 
      advances in post-transplant immunological reconstitution. All these factors 
      contribute to markedly reduce transplant-related mortality. Overall, event-free 
      survival and transplant-related mortality compare favorably with reports from 
      unrelated matched transplants. T-cell-depleted megadose stem cell transplant from 
      a mismatched family member, who is immediately available, can be offered as a 
      viable option to candidates with high-risk acute leukemias.
FAU - Aversa, Franco
AU  - Aversa F
AD  - Department of Hematology, University of Perugia, Perugia, Italy. aversa@unipg.it
FAU - Reisner, Yair
AU  - Reisner Y
FAU - Martelli, Massimo F
AU  - Martelli MF
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Blood Cells Mol Dis
JT  - Blood cells, molecules & diseases
JID - 9509932
SB  - IM
MH  - Acute Disease
MH  - Adult
MH  - *Cord Blood Stem Cell Transplantation
MH  - Disease-Free Survival
MH  - *Hematopoietic Stem Cell Transplantation
MH  - Humans
MH  - Leukemia/mortality/*therapy
MH  - Retrospective Studies
MH  - Risk Factors
MH  - *Tissue Donors
MH  - Treatment Outcome
EDAT- 2004/11/06 09:00
MHDA- 2005/04/07 09:00
CRDT- 2004/11/06 09:00
PHST- 2004/08/09 00:00 [received]
PHST- 2004/11/06 09:00 [pubmed]
PHST- 2005/04/07 09:00 [medline]
PHST- 2004/11/06 09:00 [entrez]
AID - S1079-9796(04)00178-0 [pii]
AID - 10.1016/j.bcmd.2004.08.021 [doi]
PST - ppublish
SO  - Blood Cells Mol Dis. 2004 Nov-Dec;33(3):294-302. doi: 10.1016/j.bcmd.2004.08.021.