Results of Unrelated Cord Blood Transplant in Fanconi Anemia Patients: Risk Factor Analysis for Engraftment and Survival

Eliane Gluckman, Vanderson Rocha, Irina Ionescu, Marc Bierings, Richard E. Harris, John Wagner, Joanne Kurtzberg, Martin A. Champagne, Carmem Bonfim, Marco Bittencourt, Philip Darbyshire, Manuél Nicolas Fernandez, Franco Locatelli, Ricardo Pasquini

Research output: Contribution to journalArticle

Abstract

We retrospectively analyzed results of unrelated cord blood transplantation (UCBT) in 93 Fanconi anemia (FA) patients. Median age at transplantation was 8.6 years (1-45). The units transplanted were HLA-A, -B, or -DRB1 identical in 12 cases, 1 HLA mismatch in 35 cases, and 2 or 3 HLA differences in 45 cases. The median number of nucleated cells (NC) and CD34+ cells infused of recipient weight was 4.9 × 107/kg and 1.9 × 105/kg, respectively. Participating centers selected the preparative regimen of their choice, in 57 patients (61%), it included Fludarabine. Graft-versus-host disease (GVHD) prophylaxis consisted mostly of cyclosporine with prednisone. Cumulative incidence (CI) of neutrophil recovery was 60 ± 5% at day +60. In multivariate analysis, Fludarabine containing regimen and NC infused ≥4.9 × 107/kg were associated with higher probability of recovery. CI of grade II-IV acute and of chronic GVHD (aGVHD, cGVHD) was 32% ± 5% and 16% ± 4%, respectively. Overall survival (OS) was 40% ± 5%. In multivariate analysis, factors associated with favorable outcome were use of Fludarabine in the conditioning regimen, number of NC infused ≥4.9 × 107/kg, and negative cytomegalovirus (CMV) serology in the recipient. In conclusion, factors easily modifiable such as donor selection and a Fludarabine-containing regimen can considerably improve survival in FA patients given a UCBT. These data are the basis for designing prospective protocols.

Original languageEnglish
Pages (from-to)1073-1082
Number of pages10
JournalBiology of Blood and Marrow Transplantation
Volume13
Issue number9
DOIs
Publication statusPublished - Sep 2007

Keywords

  • Fanconi anemia
  • Fludarabine
  • Unrelated cord blood transplantation

ASJC Scopus subject areas

  • Transplantation

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    Gluckman, E., Rocha, V., Ionescu, I., Bierings, M., Harris, R. E., Wagner, J., Kurtzberg, J., Champagne, M. A., Bonfim, C., Bittencourt, M., Darbyshire, P., Fernandez, M. N., Locatelli, F., & Pasquini, R. (2007). Results of Unrelated Cord Blood Transplant in Fanconi Anemia Patients: Risk Factor Analysis for Engraftment and Survival. Biology of Blood and Marrow Transplantation, 13(9), 1073-1082. https://doi.org/10.1016/j.bbmt.2007.05.015