|
Cord Blood; Findings from the United States in Cord Blood Provide New Insights
Blood Weekly
29 June 2006
2006 JUN 29 - (NewsRx.com) -- Reports from the United States highlight recent research in cord blood.
Study 1: Post-transplant lymphoproliferative disorder occurs early after umbilical cord blood transplantation in children.
According to a study from the United States, "Reported are 7 cases of post-transplant lymphoproliferative disorder (PTLD) arising in children who received umbilical cord blood transplantation (UCBT). There were 4 females and 3 males with a median age of 3 years (range, 1-16 years).
"All 7 patients received UCBT, including 1 patient who received multiple units and 1 transplanted under nonmyeloablative condition. The time interval from UCBT to PTLD averaged 4 months (range, 2 weeks to 9 months)."
"Patients typically presented with high-stage disease with visceral organ involvement. Histology of the PTLDs showed monomorphic morphology in 5 cases and polymorphic morphology in the remaining 2 cases. Bone marrow biopsies were performed in 3 cases and were negative for PTLD," J.Z. Gong and colleagues at Duke University Medical Center in Durham reported.
"Epstein-Barr virus (EBV) was detected in the PTLD in all 7 patients by in situ hybridization. Evidence of past EBV infection was found in the recipients," continued the authors, "but the EBV genome was not detected in the donor cord blood samples, suggesting that donor cord blood was not the source of EBV infection."
"The origin of the PTLD was investigated in 5 cases. PTLD was of host origin in 2 patients who failed engraftment and of donor origin in the remaining 3 patients who had complete engraftment. Four of 5 patients with monomorphic PTLD failed to demonstrate significant responses to rituximab and/or reduction of immunosuppression and died within 1 month after diagnosis.
"The remaining 2 patients with polymorphic PTLD showed complete response to therapy. One patient was alive 35 months after transplant, and the other patient died of infection 6 months after transplant," investigators wrote.
Researchers concluded that PTLD "arising after UCBT in children occurs early after transplant and represents a serious EBV-related complication. PTLD may be of donor or recipient origin depending on engraftment status. Both monomorphic and polymorphic histology may be seen, and monomorphic histology appears to predict an unfavorable prognosis."
Gong and colleagues published their study in American Journal of Surgical Pathology (Post-transplant lymphoproliferative disorder after umbilical cord blood transplantation in children. Am J Surg Pathol, 2006;30(3):328-336).
For more information, contact J.Z. Gong, Duke University Medical Center, Dept. Pathology, Box 3712, Durham, NC 27710, USA.
Publisher contact information for the American Journal of Surgical Pathology is: Lippincott Williams & Wilkins, 530 Walnut St., Philadelphia, PA 19106-3621, USA.
Study 2: Umbilical cord blood donors are readily available for children with lysosomal and peroxisomal storage disease.
"The Cord Blood Transplantation Study (COBLT), sponsored by the National Heart, Lung, and Blood Institute, is a phase II multicenter study designed to evaluate the use of cord blood in allogeneic transplantation.
"In this report, we evaluated the outcomes of cord blood transplantation in 69 patients with lysosomal and peroxisomal storage diseases," investigators in the United States report.
According to P.L. Martin and colleagues at Duke University, Medical Center in Durham, "Patients with mucopolysaccharidoses I to III, mucolipidoses (ML) II (n=36), adrenoleukodystrophy (n=8), metachromatic leukodystrophy (n=6), Krabbe disease (n=16), and Tay-Sachs disease (n=3) were enrolled between August 1999 and June 2004.
"All patients received the same preparative regimen, graft-versus-host disease (GVHD) prophylaxis, and supportive care. End points included survival, engraftment, GVHD, and toxicity. Sixty-nine patients (64% men; 81% white) with a median age of 1.8 years underwent transplantation with a median cell dose of 8.7x107/kg."
"One-year survival was 72% (95% confidence interval, 61%-83%). The cumulative incidence of neutrophil engraftment by day 42 was 78% (95% confidence interval, 67%-87%) at a median of 25 days. Grade II to IV acute GVHD occurred in 36% of patients," the authors said.
Martin concluded, "Cord blood donors are readily available for rapid transplantation. Cord blood transplantation should be considered as frontline therapy for young patients with lysosomal and peroxisomal storage diseases."
Martin and colleagues published their study in Biology of Blood and Marrow Transplantation (Results of the Cord Blood Transplantation Study (COBLT): Outcomes of unrelated donor umbilical cord blood transplantation in pediatric patients with lysosomal and peroxisomal storage diseases. Biol Blood Marrow Transplant, 2006;12(2):184-194).
For additional information, contact J. Kurtzberg, Duke University, Medical Center, Box 3350, Durham, NC 27710, USA.
Study 3: A case of donor cell-derived acute leukemia occurred following umbilical cord blood transplantation.
According to a recent report from the United States, "Donor cell leukemia is a rare complication after allogeneic hematopoietic stem cell transplantation. A 12-month-old boy underwent unrelated donor umbilical cord blood transplant (UCBT) for refractory Langerhan's cell histiocytosis. Forty months after transplantation, he developed acute myeloid leukemia.
"Cytogenetic and molecular analysis confirmed donor cell origin. The Cord Blood Bank (CBB) contacted the donor's family and established that the child, now 7 years old, was healthy," the authors said.
"This represents the first reported case of donor cell leukemia following UCBT," wrote C.J. Fraser and colleagues at the University of Minnesota.
Investigators concluded, "This case illustrates that donor cell leukemia is a rare but real event after UCBT as with other stem cell sources and highlights the need for CBBs to maintain linkage data between donors and recipients."
Fraser and colleagues published their study in Blood (First report of donor cell-derived acute leukemia as a complication of umbilical cord blood transplantation. Blood, 2005;106(13):4377-4380).
For additional information, contact C.J. Fraser, University of Minnesota, Dept. Pediatrics, Pediatrics Blood & Marrow Transplant Program, Division Hematology Oncology & Blood & Marrow Transplantation, 420 Delaware St. SE, Mayo Mail Code 484, Rm D-557, Minneapolis, MN 55455, USA.
Keywords: Minneapolis, Minnesota, United States, Langerhan Cell Histiocytosis, Donor Cell-Derived Acute Leukemia, Umbilical Cord Blood Transplantation, Rare Complication, Stem Cell Source.
This article was prepared by Blood Weekly editors from staff and other reports. Copyright 2006, Blood Weekly via NewsRx.com.
|
