Open AccessEngraftment kinetics after transplantation of double unit cord blood grafts combined with haplo-identical CD34+ cells without antithymocyte globulin
Author(s) -
Ioannis Politikos,
Sean M. Devlin,
Maria E. Arcila,
Jonathan Barone,
Molly Maloy,
Kristine Naputo,
Josel D. Ruiz,
Christopher Mazis,
Andromachi Scaradavou,
Scott T. Avecilla,
Parastoo B. Dahi,
Sergío Giralt,
Kuo-Shun Hsu,
Ann A. Jakubowski,
Esperanza B. Papadopoulos,
MiguelAngel Perales,
Craig S. Sauter,
Roni Tamari,
Doris M. Ponce,
Richard J. O’Reilly,
Juliet N. Barker
Publication year - 2020
Publication title -
leukemia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.539
H-Index - 192
eISSN - 1476-5551
pISSN - 0887-6924
DOI - 10.1038/s41375-020-0922-x
Subject(s) - cd34 , medicine , transplantation , myeloid , cord blood , gastroenterology , surgery , immunology , urology , stem cell , biology , genetics
Double unit cord blood (dCB) transplantation (dCBT) is associated with high engraftment rates but delayed myeloid recovery. We investigated adding haplo-identical CD34+ cells to dCB grafts to facilitate early haplo-identical donor-derived neutrophil recovery (optimal bridging) prior to CB engraftment. Seventy-eight adults underwent myeloablation with cyclosporine-A/mycophenolate mofetil immunoprophylaxis (no antithymocyte globulin, ATG). CB units (median CD34+ dose 1.1 × 10 5 /kg/unit) had a median 5/8 unit-recipient human leukocyte antigen (HLA)-match. Haplo-identical grafts had a median CD34+ dose of 5.2 × 10 6 /kg. Of 77 evaluable patients, 75 had sustained CB engraftment that was mediated by a dominant unit and heralded by dominant unit-derived T cells. Optimal haplo-identical donor-derived myeloid bridging was observed in 34/77 (44%) patients (median recovery 12 days). Other engrafting patients had transient bridging with second nadir preceding CB engraftment (20/77 (26%), median first recovery 12 and second 26.5 days) or no bridge (21/77 (27%), median recovery 25 days). The 2 (3%) remaining patients had graft failure. Higher haplo-CD34+ dose and better dominant unit-haplo-CD34+ HLA-match significantly improved the likelihood of optimal bridging. Optimally bridged patients were discharged earlier (median 28 versus 36 days). ATG-free haplo-dCBT can speed neutrophil recovery but successful bridging is not guaranteed due to rapid haplo-identical graft rejection.