Umbilical Cord Blood transplantation in acute leukemias

Umbilical Cord Blood transplantation in acute leukemias
Presentation by: Pablo Ramirez, M.D.
DiPersio Lab
Grand Rounds, March 2009

Topics covered are:
Clinical case
High risk cytogenetics: matched donor vs chemo
Impact of HLA mismatch on OS
Unrelated cord donor
Cord blood-derived stem cell source
First human infusion
Collection, processing and storage of UCB
Biology UCBT:
more questions than answers
Transplantation with UCB: children
Outcomes unrelated UCB vs BM: children with acute leukemia CIBMTR-USA
Probability of LFS
Transplantation with UCB: adults
Comparison between UCBT-uBMT:
European database analysis
Neutrophil recovery
Comparison between UCBT-uBMT American database analysis
Neutrophil recovery
Platelet recovery
Comparison of uBM, PB and UCB:
Conclusions from these studies and other databases
Approaches to improve rates and kinetics of engraftment
Transplantation of 2 partially HLA-matched UCB units (U of MN):
Myeloablative
Demographics
Neutrophil engraftment
Always one cord predominated: Potential contributors
GVHD
Hematologic recovery
Netrophils
Platelets
Chimerism
Higher incidence of grade II-IV aGVHD
Risk factors for TRM
Conclusions
Unresolved questions in UCBT


Umbilical Cord Blood transplantation in acute leukemias.ppt