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One-unit versus two-unit cord-blood transplantation for hematologic cancers.

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Date
2014-10
Authors
Wagner, John E
Eapen, Mary
Carter, Shelly
Wang, Yanli
Schultz, Kirk R
Wall, Donna A
Bunin, Nancy
Delaney, Colleen
Haut, Paul
Margolis, David
Peres, Edward
Verneris, Michael R
Walters, Mark
Horowitz, Mary M
Kurtzberg, Joanne
Blood and Marrow Transplant Clinical Trials Network
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Abstract
<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.).
Type
Journal article
Subject
Blood and Marrow Transplant Clinical Trials Network
Humans
Hematologic Neoplasms
Graft vs Host Disease
Histocompatibility Testing
Disease-Free Survival
Immunotherapy
Transplantation Conditioning
Cord Blood Stem Cell Transplantation
Survival Rate
Adolescent
Child
Child, Preschool
Infant
Female
Male
Young Adult
Permalink
https://hdl.handle.net/10161/24666
Published Version (Please cite this version)
10.1056/nejmoa1405584
Publication Info
Wagner, John E; Eapen, Mary; Carter, Shelly; Wang, Yanli; Schultz, Kirk R; Wall, Donna A; ... Blood and Marrow Transplant Clinical Trials Network (2014). One-unit versus two-unit cord-blood transplantation for hematologic cancers. The New England journal of medicine, 371(18). pp. 1685-1694. 10.1056/nejmoa1405584. Retrieved from https://hdl.handle.net/10161/24666.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Kurtzberg

Joanne Kurtzberg

Jerome S. Harris Distinguished Professor of Pediatrics
Dr. Kurtzberg is an internationally renowned expert in pediatric hematology/oncology, pediatric blood and marrow transplantation, umbilical cord blood banking and transplantation, and novel applications of cord blood and birthing tissues in the emerging fields of cellular therapies and regenerative medicine.   Dr. Kurtzberg serves as the Director of the Marcus Center for Cellular Cures (MC3), Director of the Pediatric Transplant and Cellular Therapy Program, Director of the Carolina
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