Unrelated cord blood transplantation feasible in adults with high-risk malignancy

07-25-2006

"A number of hematological malignancies can be cured by allogeneic stem cell transplantation but only approximately 30% of Australians have a suitable histocompatible related donor. Matched donors can be found on international registries of unrelated volunteers for a proportion of the remaining patients," researchers in Australia report.

According to K.F. Bradstock and colleagues at Westmead Hospital, "For those patients in need of an allogeneic transplant, but for whom a suitable matched related or unrelated adult donor cannot be found, the use of banked unrelated umbilical cord blood has emerged as a potential option.

"However, there is uncertainty about the applicability of this technique for the majority of adult patients as a result of limitations in the number of cells in banked cord blood units and the degree of mismatching for histocompatibility antigens."

"The aim of this study was to define the feasibility of allogeneic stem cell transplantation using single unrelated cord blood units in a cohort of adults with poor prognosis leukemia or lymphoma.

"Nine patients with hematological malignancies (five with acute myeloid leukemia, one with acute lymphoblastic leukemia, one with Hodgkin lymphoma and two with non-Hodgkin lymphomas) received transplants of cryopreserved cord blood after conditioning therapy with high-dose cyclophosphamide, total body irradiation and antithymocyte globulin," said investigators.

"Cord units contained a median 2.6x107 nucleated cells/kg recipient bodyweight and were matched for four (seven cases) or five (two cases) major histocompatibility complex class 1 and 2 antigens. Patients were given post-transplant immunosuppression with cycosporin and methylprednisolone.

"Neutrophil recovery to 0.5x109/L was seen by median day 30 after transplant in all seven patients who survived more than 1 month post-transplant. Platelet recovery to 50x109/L occurred by median day 81 in five evaluable patients. Acute graft versus host disease (GVHD) grades II-IV was seen in four of seven evaluable patients and limited chronic GVHD was seen in four of five," wrote Bradstock.

"Infection was the most common complication. Four patients died before day 100 of infection (methicillin-resistant Staphylococcus aureus septicemia, respiratory syncitial virus pneumonia), GVHD and multiorgan failure, and intracranial bleeding.

"Five patients survived 7-69 months post-transplant," continued scientists, "without evidence of relapse of the underlying malignancy."

The authors concluded, "Unrelated cord blood transplantation is feasible in adults with high-risk malignancy, with infection relating to immunocompromise being the major limitation."

Bradstock and colleagues published their study in Internal Medicine Journal (Unrelated umbilical cord blood transplantation for adults with haematological malignancies: results from a single Australian centre. Intern Med J, 2006;36(6):355-361).

For additional information, contact K.F. Bradstock, Westmead Hospital, Blood & Marrow Transplantation Service, Darcy Rd., Westmead, NSW 2145, Australia.

Publisher contact information for the Internal Medicine Journal is: Blackwell Publishing, 9600 Garsington Rd., Oxford OX4 2DQ, Oxon, England.

Keywords: Westmead, Australia, Umbilical Cord Blood Transplantation, Graft-Versus-Host Disease, Hematological Malignancy, Septicemia.

This article was prepared by Clinical Oncology Week editors from staff and other reports. Copyright 2006, Clinical Oncology Week via NewsRx.com.