No Wash Albumin-Dextran Dilution for Double-Unit Cord Blood Transplantation is Safe with High Rates of Sustained Donor Engraftment

摘要

Washing cord blood (CB) grafts involves product manipulation and may result in cell loss. We investigated double-unit CB transplantation (CBT) using red blood cell (RBC) depleted units diluted with albumin-dextran in patients with hematologic malignancies. One-hundred thirty-six patients [median 43 years (range 4–71) and 69 kilograms (kg) (range 24–111)] were transplanted with a 4–6/6 HLA-matched graft. Patients ≤ 20 kg were excluded as they only received washed units. Units were diluted a median of 8 fold to a median volume of 200 ml/unit. The median infused TNC doses were 2.7 (larger unit) and 2.0 (smaller unit) × 10⁷/kg respectively, and the median post-thaw recovery was 86%. Units were infused consecutively (median 45 minutes/unit). While only 17 patients (13%) had no infusion reactions, reactions in the remaining 119 patients were almost exclusively mild-moderate (by CTCAE v4 criteria 12 grade 1, 43 grade 2, 63 grade 3) and only 1 patient (< 1%) had a severe (grade 4) reaction. Moreover, most were easily treated. Grade 2–3 hypertension was the most common in 101 (74%) patients. The cumulative incidence of sustained donor-derived neutrophil engraftment was high: 95% in myeloablative and 94% in non-myeloablative CBT recipients. With appropriate supportive care, double-unit CBT with RBC-depleted grafts infused after albumin-dextran dilution is safe with high rates of engraftment in patients > 20 kg.