Standardized, unrelated donor cord blood transplantation in adults with hematologic malignancies

The potential role of unrelated donor cord blood transplantation (UD-CBT) i n adults remains unclear. This study reports the results of UD-CBT in 22 ad ults with hematologic malignancies following conditioning with thiotepa, bu sulfan, cyclophosphamide, and antithymocyte globulin in 21, with thiotepa, fludarabine, and antithymocyte globulin in 1, and graft-versus-host disease (GVHD) prophylaxis with cyclosporine and prednisone. Median age was 29 yea rs (range, 18-46 years), and median weight was 69.5 kg (range, 41-85 kg). H LA match was 6 of 6 in 1 case, 5 of 6 in 13 cases, and 4 of 6 in 8 cases. M edian number of nucleated cells infused was 1.71 x 10(7)/kg (range, 1.01 x 10(7)/kg to 4.96 x 10(7)/kg). All 20 patients surviving more than 30 days h ad myeloid engraftment, and only 1, who received the lowest cell dose, deve loped secondary graft failure. Median time to reach an absolute neutrophil count of at least 0.5 x 10(9)/L was 22 days (range, 13-52 days). Median tim e to platelets numbered at least 20 x 10(9)/L was 69 days (range, 49-153 da ys). Seven patients (32%) developed acute GVHD above grade II, and 9 of 10 patients at risk developed chronic GVHD, which became extensive in 4 patien ts. Twelve patients remained alive and disease-free 3 to 45 months after tr ansplantation. Disease-free survival (DFS) at 1 year was 53%. Age strongly influenced DFS (P =.01). For patients aged 30 years or younger, the DFS at 1 year was 73%. These preliminary results suggest that UD-CBT should be con sidered a reasonable alternative in young adults with hematologic malignanc y and no appropriate bone marrow donor. (C) 2001 by The American Society of Hematology.