229: Umbilical cord blood transplantation for adult patients with chronic myeloid leukemia

C. Brunstein, D. Setubal, T. DeFor, D. Weisdorf, P. McGlave, J. Miller, J. Wagner
2007 Biology of Blood and Marrow Transplantation  
Patients and Methods: Between 10/04 and 6/06, 24 patients (pts) with high risk/relapsed/refractory hematologic malignancies have undergone NST using a modification of our original Pt-TBI regimen. The median age was 60 years. The median number of prior therapies was 2 (range 0-6). Diseases transplanted included acute lymphoblastic leukemia (nϭ3), myelodysplastic syndrome (nϭ2), acute myelogenous leukemia (nϭ8), chronic lymphocytic leukemia (nϭ3), indolent non-Hodgkin's lymphoma (nϭ2), and mantle
more » ... cell lymphoma (nϭ6). Conditioning consisted of Pentostatin 4 mg/m2 daily on day -10, -9, and -8, followed by 200 cGy TBI on day -1. Post-grafting immunosuppression consisted of cyclosporine/mycophenolate mofetil. Results: Transplantation was performed using mobilized progenitor cells from matched related (nϭ8) or unrelated (nϭ16) donors. Death prior to 100 days post transplant occurred in 4 unrelated donor transplants. The median nadir values for hemoglobin, neutrophil count and platelet count were 8.9 g/dl (range 7.6-13.7), 300/mm 3 (range 0-1900), and 63/mm 3 (range 9-165) respectively. Primary graft failure/autologous recovery occurred in one patient with mantle cell lymphoma. The median values for CD3ϩ cells and WBC at day 28 were 85% and 90% donor cells respectively. The analogous median values at day 70 were 85% and 100% respectively. One pt with a myelproliferative disorder and thalidomide as his only prior therapy experienced late graft failure despite donor lymphocyte infusions. The cumulative incidence of grade II-IV acute graftversus-host disease was approximately 54% (14% in related versus 68% in unrelated donors, Pϭ0.08). The probability of extensive chronic graft-versus-host disease in patients surviving beyond 100 days is 38%. The cumulative incidence of relapse at one year post transplant is 43%. The one year probabilities of event-free and overall survival are 41% and 61% respectively. Conclusions: This modification of our original Pt-TBI regimen continues to demonstrate fairly minimal regimen related toxicity, although as expected hematologic toxicity appears to be more significant than with our prior day -21 Pentostatin regimen. Graft versus host disease continues to be a major cause of morbidity/mortality, particularly in unrelated donor transplants. Further studies will concentrate on attempting to decrease the incidence of acute and chronic graft versus host disease through the use of T-cell depletion with in vitro alemtuzumab. Timely availability of matched donors limits allo-hematopoietic transplant (HCT) options for many otherwise suitable patients. We have explored sirolimus (rapamycin) based immuno-Poster Session II 84
doi:10.1016/j.bbmt.2006.12.234 fatcat:qw67qicbxrafhlxzxsk45btdqu