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One-Unit versusTwo-Unit Cord-BloodTransplantation forHematologic Cancers John E. WagnerMary EapenShelly Carter2014 год

One-Unit versus Two-Unit Cord-Blood Transplantation for Hematologic Cancers
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Аннотация: Umbilical-cord blood has been used as the source of hematopoietic stem cells in an estimated 30,000 transplants. The limited number of hematopoietic cells in a single cord-blood unit prevents its use in recipients with larger body mass and results in delayed hematopoietic recovery and higher mortality. Therefore, we hypothesized that the greater numbers of hematopoietic cells in two units of cord blood would be associated with improved outcomes after transplantation.Between December 1, 2006, and February 24, 2012, a total of 224 patients 1 to 21 years of age with hematologic cancer were randomly assigned to undergo double-unit (111 patients) or single-unit (113 patients) cord-blood transplantation after a uniform myeloablative conditioning regimen and immunoprophylaxis for graft-versus-host disease (GVHD). The primary end point was 1-year overall survival.Treatment groups were matched for age, sex, self-reported race (white vs. nonwhite), performance status, degree of donor-recipient HLA matching, and disease type and status at transplantation. The 1-year overall survival rate was 65% (95% confidence interval [CI], 56 to 74) and 73% (95% CI, 63 to 80) among recipients of double and single cord-blood units, respectively (P=0.17). Similar outcomes in the two groups were also observed with respect to the rates of disease-free survival, neutrophil recovery, transplantation-related death, relapse, infections, immunologic reconstitution, and grade II-IV acute GVHD. However, improved platelet recovery and lower incidences of grade III and IV acute and extensive chronic GVHD were observed among recipients of a single cord-blood unit.We found that among children and adolescents with hematologic cancer, survival rates were similar after single-unit and double-unit cord-blood transplantation; however, a single-unit cord-blood transplant was associated with better platelet recovery and a lower risk of GVHD. (Funded by the National Heart, Lung, and Blood Institute and the National Cancer Institute; ClinicalTrials.gov number, NCT00412360.).
Год издания: 2014
Авторы: John E. Wagner, Mary Eapen, Shelly Carter, Yanli Wang, Kirk R. Schultz, Donna A. Wall, Nancy Bunin, Colleen Delaney, Paul R. Haut, David M. Margolis, Edward Peres, Michael R. Verneris, Mark C. Walters, Mary M. Horowitz, Joanne Kurtzberg
Издательство: Massachusetts Medical Society
Источник: New England Journal of Medicine
Ключевые слова: Hematopoietic Stem Cell Transplantation, Mesenchymal stem cell research, Neonatal Respiratory Health Research
Другие ссылки: New England Journal of Medicine (PDF)
New England Journal of Medicine (HTML)
eScholarship (California Digital Library) (PDF)
eScholarship (California Digital Library) (HTML)
Europe PMC (PubMed Central) (PDF)
Europe PMC (PubMed Central) (HTML)
PubMed Central (HTML)
PubMed (HTML)