Severe infections after single umbilical cord blood transplantation in adults with or without the co-infusion of CD34+ cells from a third-party donor: results of a multicenter study from the Grupo Español de Trasplante Hematopoyético (GETH)

Transpl Infect Dis. 2015 Apr;17(2):221-33. doi: 10.1111/tid.12361.

Abstract

Background: Umbilical cord blood transplantation (CBT) is an established alternative source of stem cells in the setting of unrelated transplantation. When compared with other sources, single-unit CBT (sCBT) is associated with a delayed hematologic recovery, which may lead to a higher infection-related mortality (IRM). Co-infusion with the sCBT of CD34+ peripheral blood stem cells from a third-party donor (TPD) (sCBT + TPDCD34+) has been shown to markedly accelerate leukocyte recovery, potentially reducing the IRM. However, to our knowledge, no comparative studies have focused on severe infections and IRM with these 2 sCBT strategies.

Methods: A total of 148 consecutive sCBT (2000-2010, median follow-up 4.5 years) were included in a multicenter retrospective study to analyze the incidence and risk factors of IRM and severe viral and invasive fungal infections (IFIs). Neutrophil engraftment occurred in 90% of sCBT (n = 77) and 94% sCBT + TPDCD34+ (n = 71) recipients at a median of 23 and 12 days post transplantation, respectively (P < 0.01).

Results: The 4-year IRM was 24% and 20%, respectively (P = 0.7), with no differences at day +30 (5% and 4%, respectively) and day +100 (10% and 8%, respectively). In multivariate analysis early status of the underlying malignancy, cytomegalovirus (CMV)-seronegative recipient and high CD34+ cell content in the cord blood unit before cryostorage (≥1.4 × 10(5) /kg) were protective of IRM. Among the causes of IRM, bacterial infections and IFIs were more common in sCBT (15% vs. 4%), while CMV disease and parasitic infections were more common in the sCBT + TPDCD34+ cohort (5% vs. 16%).

Conclusion: These data show that sCBT supported with TPDCD34(+) cells results in much shorter periods of post-transplant leukopenia, but the short- and long-term rates of IRM were comparable to those of sCBT, presumably because immune recovery is equally delayed in both graft types.

Keywords: allogeneic; cord blood transplantation; severe infections.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Antigens, CD34
  • Bacterial Infections / epidemiology*
  • Bacterial Infections / mortality
  • Busulfan / therapeutic use
  • Cohort Studies
  • Cord Blood Stem Cell Transplantation / methods*
  • Cyclosporine / therapeutic use
  • Female
  • Granulocyte Colony-Stimulating Factor / therapeutic use
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Leukemia / therapy*
  • Lymphoma / therapy*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Mycoses / epidemiology*
  • Mycoses / mortality
  • Myeloablative Agonists / therapeutic use*
  • Peripheral Blood Stem Cell Transplantation / methods*
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Thiotepa / therapeutic use
  • Transplantation Conditioning / methods
  • Vidarabine / analogs & derivatives
  • Vidarabine / therapeutic use
  • Virus Diseases / epidemiology*
  • Virus Diseases / mortality
  • Whole-Body Irradiation
  • Young Adult

Substances

  • Antigens, CD34
  • Immunosuppressive Agents
  • Myeloablative Agonists
  • Granulocyte Colony-Stimulating Factor
  • Cyclosporine
  • Thiotepa
  • Vidarabine
  • Busulfan
  • fludarabine