Table 2.

Engraftment and acute GVHD after unrelated umbilical cord blood transplantation (UCBT)

Reference no.
29 
28 
35 
General characteristics   Analysis of 562 patients receiving UCB grafts from New York Blood Center between 1992 and 1998   Multicenter (Eurocord and others) between 1988 and 1996. Results of unrelated UCBT group (n = 65) are shown   102 UCBTs at the University of Minnesota between 1994 and 2001  
Age, y (median)   82% ≤ 17   0.3-45.0 (9)   0.2-56.9 (7.4)  
  18% ≥ 18    
Donor-recipient HLA-mismatch   7% of grafts: 6/6 HLA-match   14% of grafts: 6/6 HLA-match   14% of grafts: no HLA-mm  
  39% of grafts: 1 HLA-mm   83% of grafts: 1-2 HLA-mm   84% of grafts: 1-2 HLA-mm  
  54% of grafts: 2-3 HLA-mm    
Myeloid engraftment, % (median time, d)   At day 60: 91 (28)   At day 60: 87   At day 42: 88 (23)  
Platelet engraftment, % (median time, d)   At day 180*: 85 (90)   At day 60†: 39   At day 180*: 65 (86)  
Favorable factors associated with engraftment, multivariate analysis  

  1. Higher nucleated cell dose, HLA-match, US center, and diagnosis other than chronic myeloid leukemia and aplastic anemia were associated with successful myeloid engraftment.

  2. Younger age, absence of infection after HCT, and absence of acute GVHD were associated with platelet engraftment.

 		 Recovery of neutrophil count and platelet engraftment associated with the following:  

  1. Neutrophil recovery: higher CD34+ cell dose infused (> 1.7 × 105/kg).

  2. Platelet recovery: higher CD34+ cell dose infused and absence of severe acute GVHD.

  3. No association of either with HLA match was observed.

 
  

  1. Higher number of nucleated cells infused and

  2. HLA-identity.

 		 
Grade II-IV (III-IV) acute GVHD, %   6/6 HLA-match: 27 (9)   32 (20)   39 (11)  
  1 HLA-mm: 48 (22)    
  2-3 HLA-mm: 49 (25)    
Factors associated with acute GVHD
 

  1. Older age (≤ 12 vs ≥ 12).

  2. Non-US center location.

  3. HLA mismatch (0 vs ≥ 1) approached significance (P = .06), but no correlation with number of mismatches was seen.

 

  1. No association of acute GVHD with number of HLA mismatches.

  2. CMV-seronegative status was associated with a lower risk of acute GVHD.

 		 No association with CD3 cell dose, HLA disparity or class of HLA-mismatch.
 
Reference no.
29 
28 
35 
General characteristics   Analysis of 562 patients receiving UCB grafts from New York Blood Center between 1992 and 1998   Multicenter (Eurocord and others) between 1988 and 1996. Results of unrelated UCBT group (n = 65) are shown   102 UCBTs at the University of Minnesota between 1994 and 2001  
Age, y (median)   82% ≤ 17   0.3-45.0 (9)   0.2-56.9 (7.4)  
  18% ≥ 18    
Donor-recipient HLA-mismatch   7% of grafts: 6/6 HLA-match   14% of grafts: 6/6 HLA-match   14% of grafts: no HLA-mm  
  39% of grafts: 1 HLA-mm   83% of grafts: 1-2 HLA-mm   84% of grafts: 1-2 HLA-mm  
  54% of grafts: 2-3 HLA-mm    
Myeloid engraftment, % (median time, d)   At day 60: 91 (28)   At day 60: 87   At day 42: 88 (23)  
Platelet engraftment, % (median time, d)   At day 180*: 85 (90)   At day 60†: 39   At day 180*: 65 (86)  
Favorable factors associated with engraftment, multivariate analysis  

  1. Higher nucleated cell dose, HLA-match, US center, and diagnosis other than chronic myeloid leukemia and aplastic anemia were associated with successful myeloid engraftment.

  2. Younger age, absence of infection after HCT, and absence of acute GVHD were associated with platelet engraftment.

 		 Recovery of neutrophil count and platelet engraftment associated with the following:  

  1. Neutrophil recovery: higher CD34+ cell dose infused (> 1.7 × 105/kg).

  2. Platelet recovery: higher CD34+ cell dose infused and absence of severe acute GVHD.

  3. No association of either with HLA match was observed.

 
  

  1. Higher number of nucleated cells infused and

  2. HLA-identity.

 		 
Grade II-IV (III-IV) acute GVHD, %   6/6 HLA-match: 27 (9)   32 (20)   39 (11)  
  1 HLA-mm: 48 (22)    
  2-3 HLA-mm: 49 (25)    
Factors associated with acute GVHD
 

  1. Older age (≤ 12 vs ≥ 12).

  2. Non-US center location.

  3. HLA mismatch (0 vs ≥ 1) approached significance (P = .06), but no correlation with number of mismatches was seen.

 

  1. No association of acute GVHD with number of HLA mismatches.

  2. CMV-seronegative status was associated with a lower risk of acute GVHD.

 		 No association with CD3 cell dose, HLA disparity or class of HLA-mismatch.
 

Results of 3 large peer-reviewed studies of unrelated UCBT are shown.

1, 2, or 3 HLA-mm, HLA-mismatch at 1, 2, or 3 HLA-A, -B, or -DRB1; myeloid engraftment, neutrophil count ≤ 0.5 × 109/L, first of 3 consecutive days; and platelet engraftment, ≥ 50 × 109* or ≥ 20 × 109† (untransfused) platelets/L, first of 7 days.

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