Transplantation of related and unrelated umbilical cord blood stem cells in Austria

Allogeneic bone marrow transplantation is limited by the availability of su itable HLA-matched donors and the risk of graft versus host disease (GvHD). In an attempt to overcome these limitations umbilical cord blood (UCB), ha s become a further alternative. UCB transplantations in Austria were starte d in 1991. As of September 31, 1998, six patients have been transplanted. D iagnoses were severe aplastic anaemia (SAA) (n=2), acute lymphoblastic leuk aemia (ALL) (n=1), familial hemophagocytic syndrome (FHL) (n=2) and chronic myelomonocytic leukaemia (CMML) (n=1). Three patients received UCB grafts from HLA-identical siblings and three patients from unrelated donors, of wh om two were disparate at two HLA loci (A/B) and one mismatched at one locus (C). Five patients were engrafted with complete donor hematopoiesis, with a median time of 26.5 days (range 14 to 39 days) to an ANC count of greater than or equal to 0.5 x 10(9)/L and a median time of 42.5 days (range 24 to 67 days) to a platelet count of greater than or equal to 20 x 10(9)/L. One patient with FHL had partial engraftment and died due to reactivation of c ytomegalovirus (CMV) infection and CMV pneumonia on day +25. Of the five patients surviving the post-transplant period, one with CMML ha d a relapse on day +128 and died after a HLA-matched bone marrow transplant ation from the same sibling donor in the second relapse. Another patient wi th ALL relapsed on day +200 but is still alive under palliative treatment; one patient with SAA showed graft rejection and autologous hematopoietic re constitution and later had a successful CD34+-selected allogeneic periphera l stem cell transplant from a C-locus mismatched unrelated donor. Two patients (one with SAA and one with FHL) are alive with complete remiss ion of the underlying disease. This report reflects the experience and results of UCB transplantation in A ustria and discusses the position of UCB transplantation in the context of the other stem cell alternatives available today.