Sobol U, Go A, Kliethermes S, Bufalino S, Rodriguez T, Smith S, Parthasarathy M, Stiff P
Loyola University Medical Center, Cardinal Bernardin Cancer Center, Maywood, IL, USA.
Bone Marrow Transplant. 2015 Dec;50(12):1519-25. doi: 10.1038/bmt.2015.194. Epub 2015 Sep 14.
Umbilical cord blood (UCB) as an allogeneic transplant source is generally limited to units with pre-cryopreservation total nucleated cell (TNC) doses ⩾2.5 × 10(7) NC/kg. We prospectively investigated single UCB transplantation, with cord units as low as 1 × 10(7) NC/kg, all processed with post-thaw albumin-dextran dilution. We transplanted 104 adult patients with 84% having relapsed/refractory disease. The median TNC dose was 2.1 × 10(7) NC/kg (range: 1.0-4.4 × 10(7)) and median CD34+ cell dose was 1.0 × 10(5)/kg (range: 0.0-3.7 × 10(5)/kg). Post-manipulation cell recovery and viability were 96% and 99%, respectively. Median times to neutrophil and platelet engraftment were 16 and 43 days, respectively. Univariate factors predicting neutrophil engraftment included TNC (P=0.03) and CD34+ cell dose (P=0.01). CD34+ dose predicted platelet engraftment (P<0.001). In multivariate analysis, CD34+ dose remained significant for neutrophil and platelet engraftment (P<0.0001 and P<0.0001, respectively). The 100-day and 1-year overall survival were 70% and 46%, respectively (95% confidence interval: 36%-56% at 1 year). The subset transplanted with 1-1.5 × 10(7) NC/kg had similar 100-day and 1-year survivals of 73% and 45%, respectively. Single-unit UCB transplantation using small units, processed as described, leads to favorable engraftment and acceptable outcomes in poor prognosis patients. CD34+ cell dose (⩾1.5 × 10(5)/kg) helps predict faster engraftment and can aid in graft selection.
脐带血（UCB）作为一种异基因移植来源，通常限于冻存前总核细胞（TNC）剂量≥2.5×10⁷个NC/kg的单位。我们前瞻性地研究了单份脐带血移植，使用低至1×10⁷个NC/kg的脐带血单位，所有样本均经过解冻后白蛋白-葡聚糖稀释处理。我们对104例成年患者进行了移植，其中84%患有复发/难治性疾病。TNC剂量中位数为2.1×10⁷个NC/kg（范围：1.0 - 4.4×10⁷），CD34⁺细胞剂量中位数为1.0×10⁵/kg（范围：0.0 - 3.7×10⁵/kg）。处理后细胞回收率和活力分别为96%和99%。中性粒细胞和血小板植入的中位时间分别为16天和43天。预测中性粒细胞植入的单因素包括TNC（P = 0.03）和CD34⁺细胞剂量（P = 0.01）。CD34⁺剂量可预测血小板植入（P < 0.001）。在多因素分析中，CD34⁺剂量对中性粒细胞和血小板植入仍具有显著性（分别为P < 0.0001和P < 0.0001）。100天和1年总生存率分别为70%和46%（95%置信区间：1年时为36% - 56%）。移植1 - 1.5×10⁷个NC/kg的亚组100天和1年生存率分别为73%和45%，情况相似。使用如所述处理的小单位单份脐带血移植，在预后不良患者中可实现良好的植入并获得可接受的结果。CD34⁺细胞剂量（≥1.5×10⁵/kg）有助于预测更快的植入，并可辅助移植物选择。
