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Incidence and Outcome in Delayed Cord Blood Engraftment
S148
Abstracts / Biol Blood Marrow Transplant 23 (2017) S18–S391
Table 1 Cell Dosing and Characteristics of Both Umbilical Cord Donors and Recipient
HLA- typing HLA-A Locus HLA-B Locus HLA-C Locus HLA-DR1 Locus HLA- matching Cell dose TNC (×10e8) CD34+ cells (×10e6) CD 3+ cells (×10e8) Blood group Gender CMV status
Patient
Donor 1
Donor 2
02:01 15:18 07:04 04:01
02:01 01:01 51:01 27:EKN 02:01 01:02 04:01 01:01 5/6 match
02:01 01:01 07:YMPN 27:YMXY 07:WDRZ 01:XMZY 04:01 01:01 5/6 match
19.8 8.6
16.38 7.56
7.55
3.11
A positive Male Negative
A positive Female Negative
01:01 27:05 01:02 01:01
A positive Male Positive
primary graft failure and delayed engraftment in cord HCT and the influence of these events on survival. Methods: A retrospective review was conducted between 2000 and 2016 and all cord blood HCTs included. The timing and incidence of engraftment and survival was captured and defined as: 1. expected engraftment occurring before day 28, 2. delayed engraftment after day 28, and 3. graft failure. A comparison of overall survival distributions between groups was performed using Product Limit method using the logrank test at an alpha level of .05. Univariate analysis was performed to determine if there is an association between covariates and survival time using the log-rank test at an alpha level of .2. A multivariate analysis, including covariates that were significant in the univariate analysis, was performed using Cox proportional hazards models to control for potential prognostic factors. Hazard ratios and corresponding 95% confidence intervals were calculated. Results: 90 consecutive cord HCT were captured, 2 excluded for missing data and 5 due to death before day 28. Of the remaining 83, 45% (37/83) failed to engraft by day 28. Most, 62%, (23/37) attained recovery of marrow without a second HCT at a median of 37 days. Thirty eight percent (14/ 37) of patients did not achieve engraftment or required a second BMT (n = 8) with median of 54.5 days (38-169) to 2nd HCT. The incidence of relapse of all cord HCT was 30%, 32% of expected engrafters versus 27% of delayed. Twenty-eight percent died with delayed engraftment versus 13% who underwent 2nd HCT. The risk of death was 1.33 times higher for delayed compared to expected engrafters, controlling for gender and age (95% CI: .76, 2.32). Among delayed engrafters, the risk of death is 5.30 times higher without a second HCT versus 2nd HCT, controlling for female sex (95% CI: 1.53, 18.39). Conclusion: Although primary graft failure continues to be a life-threatening complication of cord blood transplantation, second HCT improved survival. Thus, early identification of those patients who will experience primary graft failure and require second HCT may improve survival.
Figure 1. Mixed unit chimerism in peripheral blood and bone marrow.
Conclusion: Myeloablative conditioning with ATG predisposes patients receiving dUCT to higher risk of relapse.
181 Incidence and Outcome in Delayed Cord Blood Engraftment Jennifer Holter Chakrabarty 1, Sara K. Vesely 2, Michelle Bycko 3, George B. Selby 2, Ngoc Quyen T. Duong 2, Kirsten M. Williams 4. 1 Hematology/Oncology, University of Oklahoma -Peggy and Charles Stephenson Cancer Center, Oklahoma City, OK; 2 Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK; 3 Blood and Marrow Transplant, OU Medical Center, Oklahoma City, OK; 4 Center for Cancer and Immunology Research, Children’s National Medical Center, Washington, DC Incidence of graft failure in cord blood transplant in the modern era. Background: While cord blood donor source has expanded access to hematopoietic cell transplantation (HCT) for those patients without well-matched adult donors, historically, primary graft failure was a significant complication. With the advent of double cord transplantation and successful expansion protocols, the incidence of graft failure may have decreased. We sought to determine the current incidence of
182 Allogeneic Umbilical Cord Blood Infusion for Adults with Ischemic Stroke (CoBIS): Clinical Outcomes From a Phase 1 Study Joanne Kurtzberg 1, Jesse D. Troy 1, Ellen Bennett 2, Rebecca Durham 3, Elizabeth J. Shpall 4, Jonathan Wiese 5, John Volpi 6, Samir Belagaje 7, Daniel Laskowitz 2. 1 Pediatric Blood and Marrow Transplant Division, Duke University Medical Center, Durham, NC; 2 Neurology, Duke University, Durham, NC; 3 Robertson Clinical and Translational Cell
Abstracts / Biol Blood Marrow Transplant 23 (2017) S18–S391
Table 1 Cell Dosing and Characteristics of Both Umbilical Cord Donors and Recipient
HLA- typing HLA-A Locus HLA-B Locus HLA-C Locus HLA-DR1 Locus HLA- matching Cell dose TNC (×10e8) CD34+ cells (×10e6) CD 3+ cells (×10e8) Blood group Gender CMV status
Patient
Donor 1
Donor 2
02:01 15:18 07:04 04:01
02:01 01:01 51:01 27:EKN 02:01 01:02 04:01 01:01 5/6 match
02:01 01:01 07:YMPN 27:YMXY 07:WDRZ 01:XMZY 04:01 01:01 5/6 match
19.8 8.6
16.38 7.56
7.55
3.11
A positive Male Negative
A positive Female Negative
01:01 27:05 01:02 01:01
A positive Male Positive
primary graft failure and delayed engraftment in cord HCT and the influence of these events on survival. Methods: A retrospective review was conducted between 2000 and 2016 and all cord blood HCTs included. The timing and incidence of engraftment and survival was captured and defined as: 1. expected engraftment occurring before day 28, 2. delayed engraftment after day 28, and 3. graft failure. A comparison of overall survival distributions between groups was performed using Product Limit method using the logrank test at an alpha level of .05. Univariate analysis was performed to determine if there is an association between covariates and survival time using the log-rank test at an alpha level of .2. A multivariate analysis, including covariates that were significant in the univariate analysis, was performed using Cox proportional hazards models to control for potential prognostic factors. Hazard ratios and corresponding 95% confidence intervals were calculated. Results: 90 consecutive cord HCT were captured, 2 excluded for missing data and 5 due to death before day 28. Of the remaining 83, 45% (37/83) failed to engraft by day 28. Most, 62%, (23/37) attained recovery of marrow without a second HCT at a median of 37 days. Thirty eight percent (14/ 37) of patients did not achieve engraftment or required a second BMT (n = 8) with median of 54.5 days (38-169) to 2nd HCT. The incidence of relapse of all cord HCT was 30%, 32% of expected engrafters versus 27% of delayed. Twenty-eight percent died with delayed engraftment versus 13% who underwent 2nd HCT. The risk of death was 1.33 times higher for delayed compared to expected engrafters, controlling for gender and age (95% CI: .76, 2.32). Among delayed engrafters, the risk of death is 5.30 times higher without a second HCT versus 2nd HCT, controlling for female sex (95% CI: 1.53, 18.39). Conclusion: Although primary graft failure continues to be a life-threatening complication of cord blood transplantation, second HCT improved survival. Thus, early identification of those patients who will experience primary graft failure and require second HCT may improve survival.
Figure 1. Mixed unit chimerism in peripheral blood and bone marrow.
Conclusion: Myeloablative conditioning with ATG predisposes patients receiving dUCT to higher risk of relapse.
181 Incidence and Outcome in Delayed Cord Blood Engraftment Jennifer Holter Chakrabarty 1, Sara K. Vesely 2, Michelle Bycko 3, George B. Selby 2, Ngoc Quyen T. Duong 2, Kirsten M. Williams 4. 1 Hematology/Oncology, University of Oklahoma -Peggy and Charles Stephenson Cancer Center, Oklahoma City, OK; 2 Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK; 3 Blood and Marrow Transplant, OU Medical Center, Oklahoma City, OK; 4 Center for Cancer and Immunology Research, Children’s National Medical Center, Washington, DC Incidence of graft failure in cord blood transplant in the modern era. Background: While cord blood donor source has expanded access to hematopoietic cell transplantation (HCT) for those patients without well-matched adult donors, historically, primary graft failure was a significant complication. With the advent of double cord transplantation and successful expansion protocols, the incidence of graft failure may have decreased. We sought to determine the current incidence of
182 Allogeneic Umbilical Cord Blood Infusion for Adults with Ischemic Stroke (CoBIS): Clinical Outcomes From a Phase 1 Study Joanne Kurtzberg 1, Jesse D. Troy 1, Ellen Bennett 2, Rebecca Durham 3, Elizabeth J. Shpall 4, Jonathan Wiese 5, John Volpi 6, Samir Belagaje 7, Daniel Laskowitz 2. 1 Pediatric Blood and Marrow Transplant Division, Duke University Medical Center, Durham, NC; 2 Neurology, Duke University, Durham, NC; 3 Robertson Clinical and Translational Cell