Journal Article

Phase II study of intrabone single unit cord blood transplantation for hematological malignancies

Ishikawa, Yuichi, Tanimoto, Mitsune, Kobayashi, Hironori, Endo, Tomoyuki, Masuko, Masayoshi, Goto, Tatsunori, Suzuki, Ritsuro, Fukuhara, Noriko, Kiyoi, Hitoshi, Kodera, Yoshihisa, Shibasaki, Yasuhiko, Iriyama, Chisako, Inamoto, Yoshihiro, Ushijima, Yoko, Murata, Makoto, Matsushita, Tadashi, Onishi, Yasushi, Terakura, Seitaro, Naoe, Tomoki, Nishida, Tetsuya, Maeda, Yoshinobu, Fujii, Nobuharu

2017

Overview

The outcomes of cord blood transplantation with non‐irradiated reduced‐intensity conditioning for hematological malignancies need to be improved because of graft failure and delayed engraftment. Intrabone infusion of cord blood cells has the potential to resolve the problems. In this phase II study, 21 adult patients with hematological malignancy received intrabone transplantation of serological HLA‐A, B, and DR ≥4/6 matched single cord blood with a median number of cryopreserved total nucleated cells of 2.7 × 107/kg (range, 2.0–4.9 × 107/kg) following non‐irradiated fludarabine‐based reduced‐intensity conditioning. Short‐term methotrexate and tacrolimus were given as graft‐versus‐host disease prophylaxis, and granulocyte colony‐stimulating factor was given after transplantation. No severe adverse events related to intrabone injection were observed. The cumulative incidences of neutrophils ≥0.5 × 109/L, reticulocytes ≥1%, and platelets ≥20 × 109/L recoveries were 76.2%, 71.4%, and 76.2%, respectively, with median time to recoveries of 17, 28, and 32 days after transplantation, respectively. The probability of survival with neutrophil engraftment on day 60 was 71.4%, and overall survival at 1 year after transplantation was 52.4%. The incidences of grade II–IV and III–IV acute graft‐versus‐host disease were 44% and 19%, respectively, with no cases of chronic graft‐versus‐host disease. The present study showed the safety of direct intrabone infusion of cord blood. Further analysis is required to confirm the efficacy of intrabone single cord blood transplantation with non‐irradiated reduced‐intensity conditioning for adult patients with hematological malignancy. This study was registered with UMIN‐CTR, number 000000865. Twenty‐one adult patients with hematological malignancy received intrabone single unit cord blood transplantation with non‐irradiated fludarabine‐based reduced‐intensity conditioning. The cumulative incidence of neutrophil recovery was 76.2% with median time to recovery of 17 days after transplantation. Overall survival at 1 year after transplantation was 52.4%.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc
• Subject: Adolescent / Adult / Blood banks / Blood platelets / Bone marrow / Cord blood / Cord Blood Stem Cell Transplantation - adverse effects / Cord Blood Stem Cell Transplantation - methods / Cord blood transplantation / Cryopreservation / Disease prevention / Drug dosages / engraftment / Female / Fludarabine / Graft rejection / Graft vs Host Disease - epidemiology / Grafts / Hematologic Neoplasms - blood / Hematologic Neoplasms - therapy / hematological malignancy / Hematology / Histocompatibility antigen HLA / Humans / Injections / intrabone / Leukemia / Leukocytes (granulocytic) / Leukocytes (neutrophilic) / Male / Malignancy / Methotrexate / Middle Aged / Neutrophils / Neutrophils - cytology / non‐myeloablative conditioning / Original / Patients / Platelet Count / R&D / Research & development / Reticulocyte Count / Reticulocytes / Survival Analysis / Tacrolimus / Transplantation / Transplantation Conditioning / Transplants & implants / Treatment Outcome / Vidarabine - administration & dosage / Vidarabine - analogs & derivatives / Young Adult