RELATED CORD-BLOOD TRANSPLANTS - THE EUROCORD EXPERIENCE FROM 78 TRANSPLANTS

Eurocord Transplant has established a registry for studying results of cord blood transplant. We have analyzed 78 patients who have received a related CBT between October 1988 and December 1996, The median foll ow-up time was 29 months (1-99), The median age was 5 years (0.2-20), median weight 19 kg (5-50), Forty-six patients had a malignant disease : 32 acute leukemia (AL), six chronic myeloid leukemia (CML), four mye lodysplastic syndrome, two neuroblastoma and two non-Hodgkin lymphoma, Thirty-two patients were transplanted for non-malignant diseases incl uding 17 bone marrow failure syndromes (BMFS), three sickle cell anemi a, five thalassemia and seven inborn errors. The donor was an HLA-iden tical sibling in 60 cases and an HLA-mismatched donor in 18 cases. As conditioning, 36 patients received irradiation and 40 patients receive d associated busulfan-containing regimens. GVHD prophylaxis consisted of CsA alone in 36 cases, CsA associated with prednisone in eight case s, CsA, methotrexate (Mtx) with or without prednisone in 28 cases and CsA with monoclonal antibody or ATG in four cases. The median number o f nucleated cells (NC) infused/kg was 3.9 x 10(7) (0.7-15), One-year s urvival was 63 +/- 6%, Age, weight, HLA identity and negative cytomega lovirus (CMV) serology in the recipient were significant favorable pro gnostic factors. Among these 78 patients, the incidence of grade great er than or equal to II GVHD was 9% in HLA-matched CBT and 50% in misma tched CBT (P < 0.001). Neutrophil engraftment was associated with age < 6 years (P = 0.02) and weight < 20 kg (P = 0.02), It was 73% in pati ents receiving < 3.7 x 10(7) nucleated cells (NC) infused/kg and 85% i n patients receiving more (P = 0.06), Favorable factors for platelets engraftment were age < 6 years (P = 0.03), weight <20 kg (P = 0.002) a nd HLA identity (P < 0.0001). Related cord blood transplantation offer s a good alternative to BMT, Theses results are in favor of freezing c ord blood in families in whom a transplant might be indicated.