Unrelated cord blood transplantation for patients with advanced myelodysplastic syndrome
Cryopreserved umbilical cord blood (UCB) contains sufficient numbers of hematopoietic stem cells (HSC) to engraft younger pediatric patients with leukemia. Recent data demonstrate promising results in larger children and adults, as well as in patients with nonmalignant disorders. As a result, the number of UCB transplantations (UCBT) being performed is increasing dramatically. UCB has the clear benefits of rapid availability and a reduced stringency of requirement for HLA match. Furthermore, new preparative regimens combined with double-unit grafts have been associated with improved engraftment and survival in larger children and adults, making UCBT a viable potential alternative to unrelated volunteer donor transplantation, especially in preference to transplantation using mismatched volunteers.
The efficacy of umbilical cord blood (UCB) in the setting of a nonmyeloablative regimen support the use of UCB after a nonmyeloablative conditioning as a strategy for extending the availability of transplantation therapy, particularly for older patients.
Advances such as nonmyeloablative conditioning have contributed to increased utilization of allogeneic transplant in older and less fit individuals
In a prospective protocol, 110 patients having high-risk hematologic disease underwent a nonmyeloablative conditioning regimen followed by unrelated cord blood cell (UCB) transplantation. The median age was 51 years and 85% required two UCB units. Nonmyeloablative regimens reduce incidence of graft-versus-host disease better than myeloblative therapies. One hundred thirty-seven patients undergoing matched-related sibling transplantations received the same GVHD prophylaxis.”
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