Year: 2007
Type: article
Abstract: Chronic myelogenous leukemia (CML) was primarily treated with HSCT until imatinib mesilate was shown to be effective and safe for patients with early chronic phase CML. However, patients who fail imatinib therapy due to disease progression or drug intolerance still require HSCT. Umbilical cord blood (UCB) has been an increasingly used source of hematopoietic stem cells for transplantation (HSCT) of patients with hematologic malignancies who lack a suitable sibling donor. We report here on 20 adult patients who underwent UCB transplantation (UCBT) for Ph+ CML at the University of Minnesota between 1998 and 2005. Patient received myeloablative (MA, n=12) or nonmyeloablative (NMA, n=8) conditioning, The median age was 46 y (r: 18-58), 12 (60%) were male, and median weight was 78 kg (r: 57-103), and 13 (65%) were CMV positive. The MA conditioning was Bu/Cy (n=2) Cy/TBI ± ATG (n=4), or Cy/Fludarabine(Flu)/TBI (n=6). The NMA conditioning was Bu/Flu/TBI (n=2) or Cy/Flu/TBI± ATG (n=6). Posttransplantation immunosuppression was CsA alone (n=1), CsA/methylprednisolone(MP) (n=5), or CsA/MMF (n=14). Eleven patients (55%) receive a double UCB graft. The highest HLA disparity of UCB units was 4/6 (n=13), 5/6 (n=5), and 6/6 (n=2). Six patients (30%) were in first chronic phase (CP1) and 14 (70%) were in accelerated phase (AP) CML. The median TNC dose infused was 2.9 × 107/kg (r:1.2-5.3) and median CD34 dose infused was 4.8 × 105/kg (r: 0.7-12.7). The median time from diagnosis to transplant was 24.5 months (r: 6.7-118.8), and the median follow-up of surviving patients was 2.9 yrs (r: 0.7-.7.0). There were no failures of neutrophil engraftment. In the MA setting median time to neutrophil engraftment was 21d (r:13-33), grade II-IV acute GVHD was 58% (95%CI, 28-88%), 1-yr transplant related mortality (TRM) 41% (95%CI, 13-69), 2-yr relapse rate 10% (95%CI, 0-26), and overall survival 58% (95%CI, 30-86). In the NMA setting median time to neutrophil engraftment was 13d (r:5-32), grade II-IV acute GVHD was 63% (95%CI, 28-98%), 1-yr transplant related mortality (TRM) 38% (95%CI, 6-70), 2-yr relapse rate 13% (95%CI, 0-34), and overall survival 50% (95%CI, 15-85). There was no statistically significant difference between MA and NMA conditioning regimens on all outcomes. In this report we show that UCB appears to be a safe and effective HSC for transplantation of patients with CML.
Institution: University of Minnesota
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
OpenAlex ID: W2073769830