Feasibility of Reduced-Intensity Cord Blood Transplantation as Salvage Therapy for Graft Failure: Results of a Nationwide Survey of Adult Patients

Fusako Waki, Kazuhiro Masuoka, Takahiro Fukuda, Yoshinobu Kanda, Mika Nakamae, Kimikazu Yakushijin, Katsuhiro Togami, Kaichi Nishiwaki, Yasunori Ueda, Fumio Kawano, Masaharu Kasai, Koji Nagafuji, Maki Hagihara, Kazuo Hatanaka, Masafumi Taniwaki, Yoshinobu Maeda, Naoki Shirafuji, Takehiko Mori, Atae Utsunomiya, Tetsuya EtoHitoshi Nakagawa, Makoto Murata, Toshiki Uchida, Hiroatsu Iida, Kazuaki Yakushiji, Takuya Yamashita, Atsushi Wake, Satoshi Takahashi, Yoichi Takaue, Shuichi Taniguchi

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

To evaluate whether rescue with cord blood transplantation (CBT) could improve the poor survival after graft failure (GF), we surveyed the data of 80 adult patients (median age, 51 years) who received CBT within 3 months of GF (primary 64, secondary 16), with fludarabine-based reduced-intensity regimens with or without melphalan, busulfan, cyclophosphamide, and/or 2-4 Gy total-body irradiation (TBI). A median number of 2.4 × 107/kg total nucleated cells (TNC) were infused, and among the 61 evaluable patients who survived for more than 28 days, 45 (74%) engrafted. The median follow-up of surviving patients was 325 days, and the 1-year overall survival rate was 33% despite poor performance status (2-4, 60%), carryover organ toxicities (grade 3/4, 14%), and infections (82%) prior to CBT. Day 100 transplantation-related mortality was 45%, with 60% related to infectious complications. Multivariate analysis showed that the infusion of TNC ≥2.5 × 107/kg and an alkylating agent-containing regimen were associated with a higher probability of engraftment, and that high risk-status at the preceding transplantation and grade 3/4 organ toxicities before CBT were associated with an increased risk of mortality. In conclusion, in an older population of patients, our data support the feasibility of CBT with a reduced-intensity conditioning regimen for GF.

Original languageEnglish
Pages (from-to)841-851
Number of pages11
JournalBiology of Blood and Marrow Transplantation
Volume17
Issue number6
DOIs
Publication statusPublished - Jun 2011

Keywords

  • Allogeneic stem cell transplantation
  • Cord blood transplantation
  • Graft failure
  • Reduced intensity
  • Rejection

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Waki, F., Masuoka, K., Fukuda, T., Kanda, Y., Nakamae, M., Yakushijin, K., Togami, K., Nishiwaki, K., Ueda, Y., Kawano, F., Kasai, M., Nagafuji, K., Hagihara, M., Hatanaka, K., Taniwaki, M., Maeda, Y., Shirafuji, N., Mori, T., Utsunomiya, A., ... Taniguchi, S. (2011). Feasibility of Reduced-Intensity Cord Blood Transplantation as Salvage Therapy for Graft Failure: Results of a Nationwide Survey of Adult Patients. Biology of Blood and Marrow Transplantation, 17(6), 841-851. https://doi.org/10.1016/j.bbmt.2010.09.005