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Busulfan/melphalan/antithymocyte globulin followed by unrelated donor cord blood transplantation for treatment of infant leukemia and leukemia in young children: the Cord Blood Transplantation study (COBLT) experience.

Publication ,  Journal Article
Wall, DA; Carter, SL; Kernan, NA; Kapoor, N; Kamani, NR; Brochstein, JA; Frangoul, H; Goyal, RK; Horan, JT; Pietryga, D; Wagner, JE ...
Published in: Biol Blood Marrow Transplant
August 2005

A non-total body irradiation-containing preparative regimen was studied in young children (<4 years old) undergoing unrelated donor cord blood transplantation as part of the Cord Blood Transplantation trial for the treatment of acute lymphoblastic leukemia (n = 14), acute myeloid leukemia (n = 13), undifferentiated leukemia (n = 1), juvenile myelomonocytic leukemia (n = 2), and myelodysplastic syndromes (n = 2). Donor/recipient HLA matching based on low-/intermediate-resolution molecular typing for HLA-A and -B and high-resolution HLA-DRB1 typing was 5/6 or 6/6 (n = 21) or 4/6 (n = 11). The preparative therapy consisted of busulfan, melphalan, and antithymocyte globulin, with cyclosporine and corticosteroids for graft-versus-host disease (GVHD) prophylaxis. The median age was 1.6 years (range, 0.5-3.9 years), and the median weight was 10.5 kg (range, 5.8-19.5 kg). Cord blood grafts contained a median of 10.7 x 10 7 nucleated cells per kilogram (range, 4.6-29.2) and 2.6 x 10(5) CD34+ cells per kilogram (range, 0.7-8.3). The cumulative incidence (CINC) of neutrophil recovery (absolute neutrophil count >500/microL) at day 42 was 0.59 (95% confidence interval [CI], 0.44-0.78) at a median of 31 days (range, 23-55 days). The CINC and Kaplan-Meier estimates of platelet engraftment at day 180 were 0.53 (95% CI, 0.34-0.69) and 0.82 (95% CI, 0.61-1.00), respectively. CINC estimates of grade III/IV acute GVHD at day 100 and chronic GVHD at 1 year were 0.25 (95% CI, 0.09-0.41) and 0.26 (95% CI, 0.09-0.44), respectively. The CINC estimate of relapse was 0.31 (95% CI, 0.16-0.47) at 2 years. With a median follow-up of 27.8 months (range, 23.4-46.7 months), the probability of survival at 1 year was 0.47 (95% CI, 0.30-0.64). A preparative regimen containing a busulfan/melphalan/antithymocyte globulin preparative regimen is well tolerated in the setting of unrelated donor cord blood transplantation for childhood leukemia and can serve as a platform preparative regimen for intensifying host immunosuppression and antileukemic therapy to allow for improved engraftment and improved relapse-free survival.

Duke Scholars

Published In

Biol Blood Marrow Transplant

DOI

ISSN

1083-8791

Publication Date

August 2005

Volume

11

Issue

8

Start / End Page

637 / 646

Location

United States

Related Subject Headings

  • Whole-Body Irradiation
  • Transplantation Conditioning
  • Retrospective Studies
  • Melphalan
  • Male
  • Leukemia
  • Infant, Newborn
  • Infant
  • Immunosuppressive Agents
  • Immunology
 

Citation

APA
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MLA
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Wall, D. A., Carter, S. L., Kernan, N. A., Kapoor, N., Kamani, N. R., Brochstein, J. A., … COBLT Steering Committee, . (2005). Busulfan/melphalan/antithymocyte globulin followed by unrelated donor cord blood transplantation for treatment of infant leukemia and leukemia in young children: the Cord Blood Transplantation study (COBLT) experience. Biol Blood Marrow Transplant, 11(8), 637–646. https://doi.org/10.1016/j.bbmt.2005.05.003
Wall, Donna A., Shelly L. Carter, Nancy A. Kernan, Neena Kapoor, Naynesh R. Kamani, Joel A. Brochstein, Haydar Frangoul, et al. “Busulfan/melphalan/antithymocyte globulin followed by unrelated donor cord blood transplantation for treatment of infant leukemia and leukemia in young children: the Cord Blood Transplantation study (COBLT) experience.Biol Blood Marrow Transplant 11, no. 8 (August 2005): 637–46. https://doi.org/10.1016/j.bbmt.2005.05.003.
Wall DA, Carter SL, Kernan NA, Kapoor N, Kamani NR, Brochstein JA, Frangoul H, Goyal RK, Horan JT, Pietryga D, Wagner JE, Kurtzberg J, COBLT Steering Committee. Busulfan/melphalan/antithymocyte globulin followed by unrelated donor cord blood transplantation for treatment of infant leukemia and leukemia in young children: the Cord Blood Transplantation study (COBLT) experience. Biol Blood Marrow Transplant. 2005 Aug;11(8):637–646.
Journal cover image

Published In

Biol Blood Marrow Transplant

DOI

ISSN

1083-8791

Publication Date

August 2005

Volume

11

Issue

8

Start / End Page

637 / 646

Location

United States

Related Subject Headings

  • Whole-Body Irradiation
  • Transplantation Conditioning
  • Retrospective Studies
  • Melphalan
  • Male
  • Leukemia
  • Infant, Newborn
  • Infant
  • Immunosuppressive Agents
  • Immunology