Premium
Improving the outcome of cord blood transplantation: use of mobilized HSC and other cells from third party donors
Author(s) -
Fernández Manuel N.
Publication year - 2009
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2009.07766.x
Subject(s) - neutropenia , immunology , medicine , umbilical cord blood transplantation , cumulative incidence , transplantation , umbilical cord , haematopoiesis , cord blood , graft versus host disease , stem cell , human leukocyte antigen , histocompatibility , immune system , antigen , biology , chemotherapy , genetics
Summary We developed the strategy of umbilical cord blood transplants (UCBT) with co‐infusion of a limited number of highly purified mobilized haematopoietic stem cells (MHSC) from a human leucocyte antigen (HLA) unrestricted third party donor (TPD). Short post‐transplant periods of neutropenia were usually observed in adults with haematological neoplasms receiving UCBT with a relatively low cell content and 0–3 HLA mismatches after myeloablative conditioning. This resulted from an early and initially predominant engraftment of the TPD–MHSC. After a variable period of double complete TPD + UCB chimerism, final full UCB chimerism was achieved (cumulative incidence >90%) within 100 d. Early recovery of the circulating neutrophils resulting from the ‘bridge transplant’ of the TPD–MHSC reduced the incidence of serious neutropenia‐related infections, also facilitating the use of drugs with myelosuppressive side effects to combat other infections. The observed incidence of graft‐ versus ‐host disease and relapses was low, with overall and disease‐free survival curves comparable to those of HLA identical sibling transplants. Post‐transplant recovery of natural killer cells occurred soon after the transplant and B cells recovered around 6 months, but T‐cell recovery took more than 1 year. Available data show that T cell recovery derives from UCB–HSC through thymic differentiation and that cytomegalovirus (CMV)‐specific lymphocytes develop following CMV reactivations.