One-unit versus two-unit cord-blood transplantation for hematologic cancers

John E. Wagner, Mary Eapen, Shelly Carter, Yanli Wang, Kirk R. Schultz, Donna A. Wall, Nancy Bunin, Colleen Delaney, Paul Haut, David Margolis, Edward Peres, Michael R. Verneris, Mark Walters, Mary M. Horowitz, Joanne Kurtzberg

Research output: Contribution to journalArticle

145 Citations (Scopus)

Abstract

BACKGROUND Umbilical-cord blood has been used as the source of hematopoietic stem cells in an estimated 30,000 transplants. The limited number of hematopoietic cells in a single cord-blood unit prevents its use in recipients with larger body mass and results in delayed hematopoietic recovery and higher mortality. Therefore, we hypothesized that the greater numbers of hematopoietic cells in two units of cord blood would be associated with improved outcomes after transplantation.

METHODS Between December 1, 2006, and February 24, 2012, a total of 224 patients 1 to 21 years of age with hematologic cancer were randomly assigned to undergo double-unit (111 patients) or single-unit (113 patients) cord-blood transplantation after a uniform myeloablative conditioning regimen and immunoprophylaxis for graft-versushost disease (GVHD). The primary end point was 1-year overall survival.

RESULTS Treatment groups were matched for age, sex, self-reported race (white vs. nonwhite), performance status, degree of donor-recipient HLA matching, and disease type and status at transplantation. The 1-year overall survival rate was 65% (95% confidence interval [CI], 56 to 74) and 73% (95% CI, 63 to 80) among recipients of double and single cord-blood units, respectively (P = 0.17). Similar outcomes in the two groups were also observed with respect to the rates of disease-free survival, neutrophil recovery, transplantation-related death, relapse, infections, immunologic reconstitution, and grade II-IV acute GVHD. However, improved platelet recovery and lower incidences of grade III and IV acute and extensive chronic GVHD were observed among recipients of a single cord-blood unit.

CONCLUSIONS We found that among children and adolescents with hematologic cancer, survival rates were similar after single-unit and double-unit cord-blood transplantation; however, a single-unit cord-blood transplant was associated with better platelet recovery and a lower risk of GVHD.

Original languageEnglish
Pages (from-to)1685-1694
Number of pages10
JournalNew England Journal of Medicine
Volume371
Issue number18
DOIs
StatePublished - Oct 30 2014

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Fetal Blood
Transplantation
Transplants
Neoplasms
Blood Platelets
Survival Rate
Cell Count
Confidence Intervals
Hematopoietic Stem Cells
Disease-Free Survival
Neutrophils
Research Design
Tissue Donors
Recurrence
Survival
Mortality
Incidence
Infection

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Wagner, J. E., Eapen, M., Carter, S., Wang, Y., Schultz, K. R., Wall, D. A., ... Kurtzberg, J. (2014). One-unit versus two-unit cord-blood transplantation for hematologic cancers. New England Journal of Medicine, 371(18), 1685-1694. https://doi.org/10.1056/NEJMoa1405584

One-unit versus two-unit cord-blood transplantation for hematologic cancers. / Wagner, John E.; Eapen, Mary; Carter, Shelly; Wang, Yanli; Schultz, Kirk R.; Wall, Donna A.; Bunin, Nancy; Delaney, Colleen; Haut, Paul; Margolis, David; Peres, Edward; Verneris, Michael R.; Walters, Mark; Horowitz, Mary M.; Kurtzberg, Joanne.

In: New England Journal of Medicine, Vol. 371, No. 18, 30.10.2014, p. 1685-1694.

Research output: Contribution to journalArticle

Wagner, JE, Eapen, M, Carter, S, Wang, Y, Schultz, KR, Wall, DA, Bunin, N, Delaney, C, Haut, P, Margolis, D, Peres, E, Verneris, MR, Walters, M, Horowitz, MM & Kurtzberg, J 2014, 'One-unit versus two-unit cord-blood transplantation for hematologic cancers', New England Journal of Medicine, vol. 371, no. 18, pp. 1685-1694. https://doi.org/10.1056/NEJMoa1405584
Wagner JE, Eapen M, Carter S, Wang Y, Schultz KR, Wall DA et al. One-unit versus two-unit cord-blood transplantation for hematologic cancers. New England Journal of Medicine. 2014 Oct 30;371(18):1685-1694. https://doi.org/10.1056/NEJMoa1405584
Wagner, John E. ; Eapen, Mary ; Carter, Shelly ; Wang, Yanli ; Schultz, Kirk R. ; Wall, Donna A. ; Bunin, Nancy ; Delaney, Colleen ; Haut, Paul ; Margolis, David ; Peres, Edward ; Verneris, Michael R. ; Walters, Mark ; Horowitz, Mary M. ; Kurtzberg, Joanne. / One-unit versus two-unit cord-blood transplantation for hematologic cancers. In: New England Journal of Medicine. 2014 ; Vol. 371, No. 18. pp. 1685-1694.
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AU - Eapen, Mary

AU - Carter, Shelly

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AU - Wall, Donna A.

AU - Bunin, Nancy

AU - Delaney, Colleen

AU - Haut, Paul

AU - Margolis, David

AU - Peres, Edward

AU - Verneris, Michael R.

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AU - Horowitz, Mary M.

AU - Kurtzberg, Joanne

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N2 - BACKGROUND Umbilical-cord blood has been used as the source of hematopoietic stem cells in an estimated 30,000 transplants. The limited number of hematopoietic cells in a single cord-blood unit prevents its use in recipients with larger body mass and results in delayed hematopoietic recovery and higher mortality. Therefore, we hypothesized that the greater numbers of hematopoietic cells in two units of cord blood would be associated with improved outcomes after transplantation.METHODS Between December 1, 2006, and February 24, 2012, a total of 224 patients 1 to 21 years of age with hematologic cancer were randomly assigned to undergo double-unit (111 patients) or single-unit (113 patients) cord-blood transplantation after a uniform myeloablative conditioning regimen and immunoprophylaxis for graft-versushost disease (GVHD). The primary end point was 1-year overall survival.RESULTS Treatment groups were matched for age, sex, self-reported race (white vs. nonwhite), performance status, degree of donor-recipient HLA matching, and disease type and status at transplantation. The 1-year overall survival rate was 65% (95% confidence interval [CI], 56 to 74) and 73% (95% CI, 63 to 80) among recipients of double and single cord-blood units, respectively (P = 0.17). Similar outcomes in the two groups were also observed with respect to the rates of disease-free survival, neutrophil recovery, transplantation-related death, relapse, infections, immunologic reconstitution, and grade II-IV acute GVHD. However, improved platelet recovery and lower incidences of grade III and IV acute and extensive chronic GVHD were observed among recipients of a single cord-blood unit.CONCLUSIONS We found that among children and adolescents with hematologic cancer, survival rates were similar after single-unit and double-unit cord-blood transplantation; however, a single-unit cord-blood transplant was associated with better platelet recovery and a lower risk of GVHD.

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