Haematopoietic transplants combining a single unrelated cord blood unit and mobilized haematopoietic stem cells from an adult HLA-mismatched third party donor. Comparable results to transplants from HLA-identical related donors in adults with acute leukaemia and myelodysplastic syndromes

• Published in: Best practice & research. Clinical haematology 2010-06, Vol.23 (2), p.259-274
• Main Authors: Sebrango, Ana, Vicuña, Isabel, de Laiglesia, Almudena, Millán, Isabel, Bautista, Guiomar, Martín-Donaire, Trinidad, Regidor, Carmen, Cabrera, Rafael, Fernandez, Manuel N
• Format: Article
• Language: English
• Subjects: Acute Disease; Adolescent; Adult; Cord Blood Stem Cell Transplantation - methods; Female; Graft Survival; Graft vs Host Disease - mortality; Graft vs Host Disease - prevention & control; Hematopoietic Stem Cell Mobilization - methods; Hematopoietic Stem Cell Transplantation - methods; Histocompatibility Testing; HLA Antigens; Humans; Immunity, Cellular; Leukemia - metabolism; Leukemia - therapy; Male; Middle Aged; Myelodysplastic Syndromes - mortality; Myelodysplastic Syndromes - therapy; Neutropenia - etiology; Neutropenia - therapy; Recovery of Function; Recurrence; T-Lymphocytes; Tissue Donors; Transplantation, Homologous
• ISSN: 1532-1924
• DOI: 10.1016/j.beha.2010.05.002

We describe results of the strategy, developed by our group, of co-infusion of mobilized haematopoietic stem cells as a support for single-unit unrelated cord blood transplant (dual CB/TPD-MHSC transplants) for treatment of haematological malignancies in adults, and a comparative analysis of results obtained using this strategy and transplants performed with mobilized haematopoietic stem cells from related HLA-identical donors (RTD) for treatment of adults with acute leukaemia and myelodysplastic syndromes. Our data show that the dual CB/TPD-MHSC transplant strategy results in periods of post-transplant neutropenia, final rates of full donor chimerism and transplant-related mortality rates comparable to those of the RTD. Final survival outcomes are comparable in adults transplanted because of acute leukaemia, with different incidences of the complications that most influence these: a higher incidence of infections related to late recovery of protective immunity dependent on T cell functions, and a lower incidence of serious acute graft-versus-host disease and relapses. Recent advances in cord blood transplant techniques allow allogeneic haematopoietic stem cell transplantation (HSCT) to be a viable option for almost every patient who may benefit from this therapeutic approach. Development of innovative strategies to improve the post-transplant recovery of T cells function is currently the main challenge to further improving the possibilities of unrelated cord blood transplantation.