Umbilical Cord Blood Transplantation in Chinese Children... : Journal of Pediatric Hematology/Oncology (original) (raw)

Original Article

Umbilical Cord Blood Transplantation in Chinese Children With Beta-Thalassemia

Fang, Jianpei MD*; Huang, Shaoliang MD*; Chen, Chun MD*; Zhou, Dunhua MD*; Li, Chi-Kong MD†; Li, Yang MD*; Huang, Ke MD*

From the Department of Pediatrics at the *Second Affiliated Hospital of Zhongshan University, Guangzhou, and the †Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.

Received for publication August 11, 2003; accepted October 13, 2003.

Reprints: Dr. Jianpei Fang, Department of Pediatrics, The Second Affiliated Hospital of Zhongshan University, No. 107, Yan Jiang Road West, Guangzhou, People's Republic of China (e-mail: [email protected]).

Abstract

To evaluate factors affecting outcome of sibling umbilical cord blood transplantation in Chinese children with thalassemia. The authors conducted a retrospective review of all patients undergoing such transplants in a single institution. Nine children with thalassemia major were diagnosed at a median age of 12 months. They received irregular blood transfusions and suboptimal iron chelation therapy before transplant. Sibling cord blood transplant was performed at a median of 5.5 years (range 3.5–10 years). Six donors were HLA-identical; three were one- to three-antigen mismatched. The mean number of nucleated cells infused was 6.6 × 107/kg (range 3.4–12.7); the mean number of CD34+ cells infused was 3.8 × 105/kg (range 0.6–11.7). Seven patients had engraftment of donor cells. The median number of days to achieve a neutrophil count of >0.5 × 109/L was 19 days (range 10–25); the median number of days to achieve a platelet count of >20 × 109/L was 33 days (range 19–63). Of the six patients who received HLA-identical transplants, one developed grade 2 and two developed grade 1 acute graft-versus-host disease. Two of the three patients receiving mismatched cord blood did not achieve engraftment, and the other one engrafted but developed grade 4 acute graft-versus-host disease. Two patients subsequently developed secondary graft rejection and had autologous marrow regeneration before day 60 posttransplantation. With a median follow-up of 49 months (range 38–64), eight patients survived but only four were transfusion-independent. Umbilical cord blood transplant appears to have a higher chance of nonengraftment and secondary rejection. A more intensive immunosuppressive conditioning regimen may be required.