Double umbilical cord blood transplantation in patients with hematologic malignancies using a reduced-intensity preparative regimen without antithymocyte globulin

F Ostronoff, F Milano, T Gooley, J A Gutman, P McSweeney, F B Petersen, B M Sandmaier, R Storb, C Delaney, F Ostronoff, F Milano, T Gooley, J A Gutman, P McSweeney, F B Petersen, B M Sandmaier, R Storb, C Delaney

Abstract

Reduced-intensity conditioning (RIC) regimens in cord blood transplant (CBT) are increasingly utilized for older patients and those with comorbidities. However, the optimal conditioning regimen has not yet been established and remains a significant challenge of this therapeutic approach. Antithymocyte globulin (ATG) has been incorporated into conditioning regimens in order to decrease the risk of graft failure; however, use of ATG is often associated with infusion reactions and risk of post-transplant complications. We report the results of a non-ATG-containing RIC regimen, where patients received 2 Gy TBI unless they were considered to be at higher risk of graft failure, in which case they received 3 Gy of TBI. Thirty patients underwent CBT using this protocol for high-risk hematological malignancies. There was only one case of secondary and no cases of primary graft failure. At 1 year, estimates of non-relapse mortality, OS and PFS were 29%, 53% and 45%, respectively. The cumulative incidences of grade III-IV acute and chronic GVHD were 14% and 18%, respectively. In summary, the results of this study demonstrate that this non-ATG-containing conditioning regimen provides a low incidence of graft failure without increasing regimen-related toxicity.

Conflict of interest statement

Conflicts of Interest

All authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
A Cumulative incidence of neutrophil engraftment to day +100 in CBT recipients (n=27) Abbreviations: CBT, umbilical cord blood transplantation. B Cumulative incidence of platelet engraftment in CBT recipients (n=20) Abbreviations: CBT, umbilical cord blood transplantation.
Figure 2
Figure 2
A Probability of grade II-IV acute GVHD after reduced-intensity conditioning for CBT recipients. Abbreviations: GVHD, graft versus-host disease; CBT, umbilical cord blood transplantation. B Probability of chronic GVHD to 2 years after reduced-intensity conditioning for CBT recipients. Abbreviations: GVHD, graft versus-host disease; CBT, umbilical cord blood transplantation.
Figure 3
Figure 3
Probability of OS, PFS, relapse and NRM after reduced-intensity CBT. Abbreviations: OS, overall survival; PFS, progression free survival; NRM, non relapse mortality; CBT umbilical cord blood transplantation.

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