Hi Elisabeth,
I found these abstracts...
Best of Luck,
SS
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ncbi.nlm.nih.gov
Klin Padiatr. 2004 Nov-Dec;216(6):356-63. Related Articles, Links
Transplantation of haematopoietic stem cells derived from cord blood, bone marrow or peripheral blood: a single centre matched-pair analysis in a heterogeneous risk population.
Schonberger S, Niehues T, Meisel R, Bernbeck B, Laws HJ, Kogler G, Enzmann J, Wernet P, Gobel U, Dilloo D.
Department of Paediatric Oncology, Haematology and Immunology, University Children's Hospital Dusseldorf, Germany. schoenbs@uni-duesseldorf.de
BACKGROUND: Beside the transplantation of haematopoietic stem cells derived from bone marrow (BMT) and peripheral blood (PBSCT) in the absence of a well-matched donor, transplantation of cord blood (CBT) has been shown to be a valid alternative. To validate the efficacy of CBT in comparison to BMT and PBSCT we performed a single-centre based matched-pair analysis. PATIENTS AND METHODS: Between 1996 and 2003, 15 paediatric patients with non-malignant and malignant diseases of heterogenous risk underwent CBT. 198 paediatric patients undergoing BMT or PBSCT during the same time and at the same centre were available for selection as appropriate controls for matched-pair analysis. Matching criteria in descending hierarchy were disease, risk status, type of donor, age at HSCT, gender and year of transplantation. 47 % of CB grafts were < or = 4/6 HLA-matched whereas close to 90 % of grafts in the BMT and PBSCT cohorts were completely matched. RESULTS: Neutrophil engraftment was comparable in CB and BM recipients (p = 0.529) while engraftment following PBSCT occurs significantly earlier (p < 0.01). Median time to neutrophil recovery was 20 (range: 13-36), 19 (14-28) and 14 (9-24) days for the CBT, BMT and PBSCT cohort respectively. Of note contrary to the expectation, with regard to a reduced risk of Graft-versus-Host-Disease (GvHD) there was no clear advantage in the CBT cohort with a similar overall GvHD rate in all 3 groups. This observation can be attributed to the fact that in the CBT cohort the proportion of patients with an HLA-mismatched donor was higher than in the other cohorts. Rate of death of complications (DOC) was high in CB recipients (40 %), but not statistically different from BM (27 %) and PBSC recipients (13 %). In contrast to the CBT and BMT cohort with only 1 patient dead of disease (DOD), 4 PBSC recipients (31 %) died suffering from a relapse. 2-year event-free survival (EFS) in patients with malignant disease was 38.5 %, 69.2 % and 33.0 % for the CBT, BMT and PBSCT cohort respectively. 5-year overall survival (OS) was 53.3 % in the CBT, 66.4 % in the BMT and 50.9 % in the PBSCT cohort. There was no statistical difference between the cohorts transplanted with CB and BM or PBSC regarding EFS and OS (EFS: p = 0.24 and p = 0.72; OS: p = 0.53 and p = 0.64). CONCLUSIONS: Transplantation of < or = 4/6 HLA-matched CB grafts seems to be associated with a higher risk of GvHD, graft rejection and lethal opportunistic infection. With an overall survival of 53 % in our 15 patients this analysis documents that even in high risk patients, CB may be a valid alternate HSC source in children who lack a well-matched donor. This is especially true, if a > 4/6 HLA-matched CB with > 2.0 x 10 (7) total nucleated cells/kg bodyweight is available. Thus, parallel to the search for a BM or PBSC donor, searching for an adequate CB unit should be initiated.
PMID: 15565551 [PubMed - indexed for MEDLINE]
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ncbi.nlm.nih.gov
1: N Engl J Med. 2004 Nov 25;351(22):2276-85. Related Articles, Links
Comment in:
N Engl J Med. 2004 Nov 25;351(22):2255-7.
N Engl J Med. 2004 Nov 25;351(22):2328-30.
N Engl J Med. 2005 Mar 3;352(9):935-7; author reply 935-7.
N Engl J Med. 2005 Mar 3;352(9):935-7; author reply 935-7.
Transplants of umbilical-cord blood or bone marrow from unrelated donors in adults with acute leukemia.
Rocha V, Labopin M, Sanz G, Arcese W, Schwerdtfeger R, Bosi A, Jacobsen N, Ruutu T, de Lima M, Finke J, Frassoni F, Gluckman E; Acute Leukemia Working Party of European Blood and Marrow Transplant Group; Eurocord-Netcord Registry.
Hopital Saint-Louis, Assistance Publique des Hopitaux de Paris and Paris University, Paris, France.
BACKGROUND: Promising results of cord-blood transplants from unrelated donors have been reported in adults. METHODS: We compared outcomes in 682 adults with acute leukemia who received a hematopoietic stem-cell transplant from an unrelated donor: 98 received cord blood and 584 received bone marrow. The transplantations were performed from 1998 through 2002 and reported to Eurocord and the European Blood and Marrow Transplant Group. RESULTS: Recipients of cord blood were younger than recipients of bone marrow (median, 24.5 vs. 32 years of age; P<0.001), weighed less (median, 58 vs. 68 kg; P<0.001), and had more advanced disease at the time of transplantation (52 percent vs. 33 percent, P<0.001). All marrow transplants were HLA matched, whereas 94 percent of cord-blood grafts were HLA mismatched (P<0.001). The median number of nucleated cells that were infused was 0.23x10(8) per kilogram of the recipient's body weight for cord blood and 2.9x10(8) per kilogram for bone marrow (P<0.001). Multivariate analysis showed lower risks of grade II, III, or IV acute graft-versus-host disease (GVHD) after cord-blood transplantation (relative risk, 0.57; 95 percent confidence interval, 0.37 to 0.87; P=0.01), but neutrophil recovery was significantly delayed (relative risk, 0.49; 95 percent confidence interval, 0.41 to 0.58; P<0.001). The incidence of chronic GVHD, transplantation-related mortality, relapse rate, and leukemia-free survival were not significantly different in the two groups. CONCLUSIONS: Cord blood from an unrelated donor is an alternative source of hematopoietic stem cells for adults with acute leukemia who lack an HLA-matched bone marrow donor. Copyright 2004 Massachusetts Medical Society.
PMID: 15564544 [PubMed - indexed for MEDLINE] |
