1. Umbilical cord blood transplantation in adults with advanced hodgkin's disease: high incidence of post-transplant lymphoproliferative disease.
- Author
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Piñana JL, Sanz J, Esquirol A, Martino R, Picardi A, Barba P, Parody R, Gayoso J, Montesinos P, Guidi S, Terol MJ, Moscardó F, Solano C, Arcese W, Sanz MA, Sierra J, and Sanz G
- Subjects
- Acute Disease, Adult, Antilymphocyte Serum therapeutic use, Busulfan therapeutic use, Chronic Disease, Cyclophosphamide therapeutic use, Female, Graft Survival, Graft vs Host Disease immunology, Graft vs Host Disease mortality, Graft vs Host Disease pathology, Graft vs Host Disease prevention & control, Herpesvirus 4, Human pathogenicity, Hodgkin Disease immunology, Hodgkin Disease mortality, Hodgkin Disease pathology, Humans, Infectious Mononucleosis immunology, Infectious Mononucleosis mortality, Infectious Mononucleosis pathology, Male, Middle Aged, Recurrence, Survival Analysis, Thiotepa therapeutic use, Vidarabine analogs & derivatives, Vidarabine therapeutic use, Cord Blood Stem Cell Transplantation adverse effects, Hodgkin Disease therapy, Infectious Mononucleosis etiology, Myeloablative Agonists therapeutic use, Transplantation Conditioning
- Abstract
We report the outcome of 30 consecutive patients with Hodgkin disease (HD) who underwent single-unit UCBT. Most (90%) patients had failed previous autologous hematopoietic stem cell transplantation. The conditioning regimens were based on combinations of thiotepa, busulfan, cyclophosphamide or fludarabine, and antithymocyte globulin. The cumulative incidence (CI) of myeloid engraftment was 90% [95% confidence interval (C.I.), 74-98%] with a median of 18 d (range, 10-48). CI of acute graft-versus-host disease (GvHD) grades II-IV was 30% (95% C.I., 17-44%), while the incidence of chronic GVHD was 42% (95% C.I., 23-77%). The non-relapse mortality (NRM) at 100 d and 4 yr was 30% (95% C.I., 13-46%) and 47% (95% C.I., 29-65%), respectively. EBV-related post-transplant lymphoproliferative disease (EBV-PTLD) accounted for more than one-third of transplant-related death, with an estimate incidence of 26% (95% C.I., 9-44). The incidence of relapse at 4 yr was 25% (95% C.I., 9-42%). Four-year event-free survival (EFS) and overall survival (OS) were 28% and 30%, respectively. Despite a high NRM and an unexpected high incidence of EBV-PTLD, UCBT in heavily pretreated HD patients is an option for patients lacking a suitable adult donor, provided the disease is not in refractory relapse., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Published
- 2016
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