Umbilical cord blood transplantation in adults: Results of the prospective cord blood transplantation (COBLT)

Kenneth Cornetta, Mary Laughlin, Shelly Carter, Donna Wall, Joel Weinthal, Colleen Delaney, John Wagner, Robert Sweetman, Philip McCarthy, Nelson Chao

Research output: Contribution to journalArticle

112 Citations (Scopus)

Abstract

The Cord Blood Transplantation study group conducted a prospective study of unrelated cord blood transplantation (CBT) to better define the role of this stem cell source for subjects requiring unrelated allogeneic transplantation. We report on 1 stratum of the study designated for adult subjects. The primary end point of the study was survival at 180 days. Secondary end points included engraftment, graft-versus-host disease, relapse, and long-term survival. Eligibility criteria for malignant and nonmalignant diseases were specified. Subjects with active central nervous system disease, Karnofsky performance status <70%, grade 3 or 4 or primary myelofibrosis, or suitable related donors were excluded. Enrollment required a single cord blood unit containing >107 nucleated cells per kilogram of recipient weight and matched at ≥4 HLA-A and -B (low or intermediate resolution) and -DRB1 (high resolution) types. Thirty-four subjects were entered, with a median age of 34.5 years (range, 18.2-55 years). Most subjects (n = 23) had a 4 of 6 match, 10 subjects had a 5 of 6 match, and 1 subject had a 6 of 6 match. Diagnoses at transplantation included acute myelogenous leukemia (n = 19), acute lymphoblastic leukemia (n = 9), chronic myelogenous leukemia (n = 3), myelodysplastic syndrome (n = 1), paroxysmal nocturnal hemoglobinuria (PNH) (n = 1), and non-Hodgkin lymphoma (n = 1); 94% were classified as poor risk according to National Marrow Donor Program criteria. Subjects received total body irradiation/cyclophosphamide (n = 27) or busulfan/melphalan (n = 7) conditioning regimens. Four subjects died before CBT and are described here but are not included in the main analysis. The cumulative incidence rates and median times to neutrophil (500/μL) and platelet (>20 000/μL) engraftment were 0.66 by day 42 (median, 31 days) and 0.35 by day 180 (median, 117 days). The cumulative incidence rate for grade II-IV GVHD was 0.34 by day 100. For the primary end point, survival at 180 days, Kaplan-Meier survival estimates were 0.30 (95% confidence interval, 0.14-0.46) by day 180 after transplantation. To date there are 2 survivors, and both are >36 months from enrollment. A retrospective analysis was performed by using high-resolution HLA-A and -B typing, which revealed that approximately one third of subjects had 1 or more additional HLA mismatches compared with results of low- or intermediate-resolution HLA typing. The findings of high treatment-related mortality and slow engraftment kinetics indicate that CBT should continue to be performed in specialized centers with a research focus on cord blood cells.

Original languageEnglish
Pages (from-to)149-160
Number of pages12
JournalBiology of Blood and Marrow Transplantation
Volume11
Issue number2
DOIs
StatePublished - Feb 2005

Fingerprint

Fetal Blood
Transplantation
HLA-A Antigens
HLA-B Antigens
Paroxysmal Hemoglobinuria
Karnofsky Performance Status
Busulfan
Histocompatibility Testing
Melphalan
Survival
Whole-Body Irradiation
Central Nervous System Diseases
Myelodysplastic Syndromes
Incidence
Homologous Transplantation
Kaplan-Meier Estimate
Graft vs Host Disease
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Acute Myeloid Leukemia

Keywords

  • COBLT
  • Cord blood
  • Hematopoietic stem cell transplantation

ASJC Scopus subject areas

  • Transplantation

Cite this

Umbilical cord blood transplantation in adults : Results of the prospective cord blood transplantation (COBLT). / Cornetta, Kenneth; Laughlin, Mary; Carter, Shelly; Wall, Donna; Weinthal, Joel; Delaney, Colleen; Wagner, John; Sweetman, Robert; McCarthy, Philip; Chao, Nelson.

In: Biology of Blood and Marrow Transplantation, Vol. 11, No. 2, 02.2005, p. 149-160.

Research output: Contribution to journalArticle

Cornetta, K, Laughlin, M, Carter, S, Wall, D, Weinthal, J, Delaney, C, Wagner, J, Sweetman, R, McCarthy, P & Chao, N 2005, 'Umbilical cord blood transplantation in adults: Results of the prospective cord blood transplantation (COBLT)', Biology of Blood and Marrow Transplantation, vol. 11, no. 2, pp. 149-160. https://doi.org/10.1016/j.bbmt.2004.11.020
Cornetta, Kenneth ; Laughlin, Mary ; Carter, Shelly ; Wall, Donna ; Weinthal, Joel ; Delaney, Colleen ; Wagner, John ; Sweetman, Robert ; McCarthy, Philip ; Chao, Nelson. / Umbilical cord blood transplantation in adults : Results of the prospective cord blood transplantation (COBLT). In: Biology of Blood and Marrow Transplantation. 2005 ; Vol. 11, No. 2. pp. 149-160.
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