Umbilical cord blood transplantation in adults with haematological malignancies – UK Single Centre Pilot Study

Ref ID: 18572

Author:

M.M. Ceesay, Z.Y. Lim, S. Querol, M. Kenyon, A. Ho, A. Mijovic,
S. Devereux, R. Ireland, J. Marsh, G.J. Mufti, A. Pagliuca

Author address:

King’s College Hospital (London, UK)

Full conference title:

Annual Meeting of the EBMT, 36th

Abstract:

Recent results of adults who received umbilical cord blood
(UBC) allografts have been extremely promising, with overall and disease free survival data being comparable to transplantation using adult VUD. However, the UK has been slow
in embracing this type of program. We report on preliminary
results from a single centre pilot study evaluating the feasibility
of UBC allografts for adults in UK.
Between July 2006 and October 2009 a total of 23 adults
were transplanted using 11 single UBC and 13 double UCB
(one patient had 2 transplants). Use of single or double UCB
was based on the recipient weight. Diagnoses at transplantation were AML (n = 11), MDS (n = 5), ALL (n = 3), CML (n = 2),
aplastic anaemia (n = 2) and non-Hodgkin’s lymphoma (n = 1).
Patients received partial HLA-matched UCB grafts using 3 different protocols: Fludarabine, Cylophosphamide, TBI and ATG
for the double UCB (n = 10), Thiotepa, Fludarabine, Busulphan
and ATG for the single UCB (n = 10) and FCC (Fludarabine,
Cyclosphosphamide and Alemtuxumab (n = 4) for marrow
failures. Cyclosporine and Mycophenolate were used as the
standard GVHD prophylaxis except in FCC where cyclosporine
alone was used. The median age was 40 (range 17-72) years.
The median total nucleated cell dose (TNC) and cryopreserved
CD34 + cell dose were 2.7 x 10
7
/kg and 1.0 x 10
5
/kg respectively. The median time to sustained neutrophil engraftment
was 21.0 (range 6-39) days. Four patients had primary graft
failure and 2 others died before engraftment. There were no
cases of grade III-IV acute GVHD and only one case of chronic
extensive gut GVHD. The day 100 and 1 year transplant related
mortality (TRM) was 9% and 41% respectively. Causes of TRM
included: infection (n = 5) (CMV/adenovirus reactivation = 2,
pseudomonas = 1, aspergillosis = 1 and CNS toxoplasmosis = 1),
pulmonary haemorrhage (n = 1), intracerebral bleed/EBV PTLD
(n = 1) and hepatic VOD (n = 1). Relapse occurred in only
2 patients and both died at day 63 and 117 post transplant. The
overall survival (OS) at one year was 59%. However, the 1-year
OS for patients > 55 yrs was 17% vs. 72% for <55 yrs (P = 0.03). There was no signifi cant difference in outcome between the different protocols or disease types (P = 0.11). Our preliminary UK experience is consistent with existing literature regarding the feasibility of UCB allografts for adults. The use of our protocols has been associated with a low incidence of GVHD and relapse, but infective complications remain a major challenge.

Abstract Number: P602

Conference Year: 2010

Link to conference website: NULL

New link: NULL

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