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  • Engraftment kinetics after ...
    Politikos, Ioannis; Devlin, Sean M; Arcila, Maria E; Barone, Jonathan C; Maloy, Molly A; Naputo, Kristine A; Ruiz, Josel D; Mazis, Christopher M; Scaradavou, Andromachi; Avecilla, Scott T; Dahi, Parastoo B; Giralt, Sergio A; Hsu, Katherine C; Jakubowski, Ann A; Papadopoulos, Esperanza B; Perales, Miguel A; Sauter, Craig S; Tamari, Roni; Ponce, Doris M; O'Reilly, Richard J; Barker, Juliet N

    Leukemia, 03/2021, Letnik: 35, Številka: 3
    Journal Article

    Double unit cord blood (dCB) transplantation (dCBT) is associated with high engraftment rates but delayed myeloid recovery. We investigated adding haplo-identical CD34+ cells to dCB grafts to facilitate early haplo-identical donor-derived neutrophil recovery (optimal bridging) prior to CB engraftment. Seventy-eight adults underwent myeloablation with cyclosporine-A/mycophenolate mofetil immunoprophylaxis (no antithymocyte globulin, ATG). CB units (median CD34+ dose 1.1 × 10 /kg/unit) had a median 5/8 unit-recipient human leukocyte antigen (HLA)-match. Haplo-identical grafts had a median CD34+ dose of 5.2 × 10 /kg. Of 77 evaluable patients, 75 had sustained CB engraftment that was mediated by a dominant unit and heralded by dominant unit-derived T cells. Optimal haplo-identical donor-derived myeloid bridging was observed in 34/77 (44%) patients (median recovery 12 days). Other engrafting patients had transient bridging with second nadir preceding CB engraftment (20/77 (26%), median first recovery 12 and second 26.5 days) or no bridge (21/77 (27%), median recovery 25 days). The 2 (3%) remaining patients had graft failure. Higher haplo-CD34+ dose and better dominant unit-haplo-CD34+ HLA-match significantly improved the likelihood of optimal bridging. Optimally bridged patients were discharged earlier (median 28 versus 36 days). ATG-free haplo-dCBT can speed neutrophil recovery but successful bridging is not guaranteed due to rapid haplo-identical graft rejection.