TY - JOUR
T1 - Optimizing selection of double cord blood units for transplantation of adult patients with malignant diseases
AU - Fatobene, Giancarlo
AU - Volt, Fernanda
AU - Moreira, Frederico
AU - Mariano, Lívia
AU - Chevallier, Patrice
AU - Furst, Sabine
AU - Labussi Ére-Wallet, Hélène
AU - De La Tour, Régis Peffault
AU - Deconinck, Eric
AU - Cluzeau, Thomas
AU - Russell, Nigel
AU - Karakasis, Dimitrios
AU - Forcade, Edouard
AU - Ruggeri, Annalisa
AU - Gluckman, Eliane
AU - Rocha, Vanderson
N1 - Publisher Copyright:
© 2020 by The American Society of Hematology.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/12/22
Y1 - 2020/12/22
N2 - Double-unit unrelated cord blood transplantation (DUCBT) is an option in patients for whom a single unit is not sufficient to provide an adequate number of cells. As current guidelines on UCB unit selection are mainly based on single-unit UCB data, we performed a retrospective analysis of 1375 adult recipients of DUCBT for hematologic malignancies to determine optimal criteria for graft selection. Cryopreserved total nucleated cells (TNCs; ≤3.5 vs >3.5 × 107/kg: hazard ratio [HR], 1.53; 30% vs 45%; P =.01), number of HLA mismatches (≥2 vs 0-1: HR, 1.28; 42% vs 48%; = 5 .01), and ABO compatibility (minor/major ABO incompatibility vs compatibility: HR, 1.28; = 5 .04) were independent risk factors for OS. Cryopreserved CD34+ cell dose ≥0.7 × 105/kg in the winning UCB was associated with improved OS (HR, 1.34; = 5 .03). Low TNC (≤3.5 × 107/kg) and CD34+ (≤1.4 × 105/kg) cell doses were related to decreased neutrophil recovery (HR, 0.65 [P = .01] and HR, 0.81 [P = .01], respectively). DUCBT recipients with ≥2 HLA mismatches had a higher incidence of grade II-IV and III-IV acute graft-versus-host disease (HR, 1.26 [P = .03] and 1.59 [P = .02], respectively). Low TNC dose (HR, 1.57; P = .02) and receiving UCB with ≥2 HLA mismatches (HR, 1.35; P=.03) were associatedwith increased transplant-related mortality. Our data support selecting adequately HLA-matched UCB units with a double-unit cryopreserved TNC dose .3.5 × 107/kg and CD34+ cell dose of ≥0.7 × 105/kg per unit in DUCBT candidates.
AB - Double-unit unrelated cord blood transplantation (DUCBT) is an option in patients for whom a single unit is not sufficient to provide an adequate number of cells. As current guidelines on UCB unit selection are mainly based on single-unit UCB data, we performed a retrospective analysis of 1375 adult recipients of DUCBT for hematologic malignancies to determine optimal criteria for graft selection. Cryopreserved total nucleated cells (TNCs; ≤3.5 vs >3.5 × 107/kg: hazard ratio [HR], 1.53; 30% vs 45%; P =.01), number of HLA mismatches (≥2 vs 0-1: HR, 1.28; 42% vs 48%; = 5 .01), and ABO compatibility (minor/major ABO incompatibility vs compatibility: HR, 1.28; = 5 .04) were independent risk factors for OS. Cryopreserved CD34+ cell dose ≥0.7 × 105/kg in the winning UCB was associated with improved OS (HR, 1.34; = 5 .03). Low TNC (≤3.5 × 107/kg) and CD34+ (≤1.4 × 105/kg) cell doses were related to decreased neutrophil recovery (HR, 0.65 [P = .01] and HR, 0.81 [P = .01], respectively). DUCBT recipients with ≥2 HLA mismatches had a higher incidence of grade II-IV and III-IV acute graft-versus-host disease (HR, 1.26 [P = .03] and 1.59 [P = .02], respectively). Low TNC dose (HR, 1.57; P = .02) and receiving UCB with ≥2 HLA mismatches (HR, 1.35; P=.03) were associatedwith increased transplant-related mortality. Our data support selecting adequately HLA-matched UCB units with a double-unit cryopreserved TNC dose .3.5 × 107/kg and CD34+ cell dose of ≥0.7 × 105/kg per unit in DUCBT candidates.
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U2 - 10.1182/bloodadvances.2020002258
DO - 10.1182/bloodadvances.2020002258
M3 - Article
AN - SCOPUS:85098082648
VL - 4
SP - 6327
EP - 6335
JO - Blood advances
JF - Blood advances
SN - 2473-9529
IS - 24
ER -