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The Cord Blood Apgar: a novel scoring system to optimize selection of banked cord blood grafts for transplantation (CME)
Author(s) -
Page Kristin M.,
Zhang Lijun,
Mendizabal Adam,
Wease Stephen,
Carter Shelly,
Shoulars Kevin,
Gentry Tracy,
Balber Andrew E.,
Kurtzberg Joanne
Publication year - 2012
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2011.03278.x
Subject(s) - medicine , umbilical cord , cord blood , univariate analysis , transplantation , umbilical cord blood transplantation , hematopoietic stem cell transplantation , immunology , multivariate analysis
BACKGROUND: Engraftment failure and delays, likely due to diminished cord blood unit (CBU) potency, remain major barriers to the overall success of unrelated umbilical cord blood transplantation (UCBT). To address this problem, we developed and retrospectively validated a novel scoring system, the Cord Blood Apgar (CBA), which is predictive of engraftment after UCBT. STUDY DESIGN AND METHODS: In a single‐center retrospective study, utilizing a database of 435 consecutive single cord myeloablative UCBTs performed between January 1, 2000, to December 31, 2008, precryopreservation and postthaw graft variables (total nucleated cell, CD34+, colony‐forming units, mononuclear cell content, and volume) were initially correlated with neutrophil engraftment. Subsequently, based on the magnitude of hazard ratios (HRs) in univariate analysis, a weighted scoring system to predict CBU potency was developed using a randomly selected training data set and internally validated on the remaining data set. RESULTS: The CBA assigns transplanted CBUs three scores: a precryopreservation score (PCS), a postthaw score (PTS), and a composite score (CS), which incorporates the PCS and PTS values. CBA‐PCS scores, which could be used for initial unit selection, were predictive of neutrophil (CBA‐PCS ≥ 7.75 vs. <7.75, HR 3.5; p < 0.0001) engraftment. Likewise, CBA‐PTS and CS scores were strongly predictive of Day 42 neutrophil engraftment (CBA‐PTS ≥ 9.5 vs. <9.5, HR 3.16, p < 0.0001; CBA‐CS ≥ 17.75 vs. <17.75, HR 4.01, p < 0.0001). CONCLUSION: The CBA is strongly predictive of engraftment after UCBT and shows promise for optimizing screening of CBU donors for transplantation. In the future, a segment could be assayed for the PTS score providing data to apply the CS for final CBU selection.