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Umbilical Cord Blood Transplantation Using Reduced-intensity Conditioning without Antithymocyte Globulin in Adult Patients with Severe Aplastic Anemia.

08:00 EDT 3rd October 2018 | BioPortfolio

Summary of "Umbilical Cord Blood Transplantation Using Reduced-intensity Conditioning without Antithymocyte Globulin in Adult Patients with Severe Aplastic Anemia."

Umbilical cord blood transplantation (UCBT) is a possible option for aplastic anemia (AA) patients without a related or unrelated human leukocyte antigen-matched donor, particularly if immunosuppressive therapy (IST) has failed, or an urgent transplant is needed. However, a higher rate of graft failure after UCBT remains a major problem, and the optimal conditioning regimen for stable engraftment after UCBT has not been established. Here, we investigated six adult AA patients who underwent UCBT using a reduced-intensity conditioning (RIC) regimen comprising fludarabine 125 mg/m, cyclophosphamide 120 mg/kg, and 4 Gy total body irradiation (Flu/CY/TBI4Gy) and in the absence of antithymocyte globulin (ATG). Five patients received UCBT after IST failure, and one patient received UCBT as a first-line treatment due to a fulminant clinical finding of a neutrophil count of 0, despite granulocyte-colony stimulating factor administration. Regarding graft-versus-host disease (GVHD) prophylaxis, we used tacrolimus plus short-term methotrexate (n = 2) or tacrolimus plus mycophenolate mofetil (n = 4), and all patients achieved sustained engraftment of both neutrophils and platelets at a median of days 17.5 (range: 14-37 days) and 38.5 (range: 31-86 days), respectively, with complete donor chimerism confirmed in all patients at a median of day 14 (range: days 14-32). Three patients developed grade II acute (a)GVHD, but grades III or IV aGVHD were not observed, whereas four patients developed chronic GVHD involving only skin. All six patients remain alive without the need for blood transfusion at a median follow-up of 12 months (range: 8-127 months). Although further study is required, our findings suggested that conditioning of Flu/CY/TBI4Gy without ATG might allow stable engraftment in UCBT for adult AA patients.

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Journal Details

This article was published in the following journal.

Name: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
ISSN: 1523-6536
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Medical and Biotech [MESH] Definitions

Preparative treatment of transplant recipient with various conditioning regimens including radiation, immune sera, chemotherapy, and/or immunosuppressive agents, prior to transplantation. Transplantation conditioning is very common before bone marrow transplantation.

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Venous vessels in the umbilical cord. They carry oxygenated, nutrient-rich blood from the mother to the FETUS via the PLACENTA. In humans, there is normally one umbilical vein.

Specialized arterial vessels in the umbilical cord. They carry waste and deoxygenated blood from the FETUS to the mother via the PLACENTA. In humans, there are usually two umbilical arteries but sometimes one.

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