1. UMBILICAL CORD BLOOD TRANSPLANTATION Dr Federico GARNIER Associate Director Bone Marrow Donor Registry France Greffe de Moelle
2. UMBILICAL CORD BLOOD TRANSPLANTATION Conflict of Interest/Financial Disclosure The Speaker voluntarily disclosed the following pertinent financial relationships and/or conflicts of interest: I have NO conflicts of interest
4. Estimated probability of finding a donor in candidates for HSCT Candidates for cord blood or haplo SCT
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6. HEMATOPOIETIC RECONSTITUTION IN A PATIENT WITH FANCONI’S ANEMIA BY MEANS OF UMBILICAL-CORD BLOOD FROM AN HLA-IDENTICAL SIBLING Gluckman E, Broxmeyer HA, Auerbach A et al. New England J Med 1989;321:1174-78 A single unit of Umbilical Cord Blood contained enough haematopoietic stem cells to reconstitute definitely the host lympho-haematopoitic compartment
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8. Related Cord Blood Transplants n=78 ANC recovery according to NC and HLA matching days 0 ,1 ,2 ,3 ,4 ,5 ,6 ,7 ,8 ,9 1 0 10 20 30 40 50 60 HLA match HLA mismatch p = 0.04 0 ,1 ,2 ,3 ,4 ,5 ,6 ,7 ,8 ,9 1 0 10 20 30 40 50 60 > 3.7 x10 7 /kg < 3.7 x10 7 /kg p = 0.05 days Gluckman E, et al, NEJM 1997
9. Unrelated Cord Blood Transplants n=65 Gluckman E, et al, NEJM 1997 ANC recovery according to NC and HLA matching days 0 ,1 ,2 ,3 ,4 ,5 ,6 ,7 ,8 ,9 1 0 10 20 30 40 50 60 > 3.7x10 7 /kg < 3.7x10 7 /kg p = 0.008 days 0 ,1 ,2 ,3 ,4 ,5 ,6 ,7 ,8 ,9 1 0 10 20 30 40 50 60 HLA match HLA mismatch p = 0.03
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13. Unrelated Cord Blood versus allele typing Unrelated Bone Marrow Transplants in Children with Acute Leukemia M Eapen et al on behalf of CIBMTR and NYBC
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15. Neutrophil Recovery Days 0 20 40 100 Probability, % 100 0 20 40 60 80 80 60 BM (n=116), 97% CB matched (n=35), 85% CB MM high dose >3.5 (n=362), 79% CB MM low dose<3.5 (n=97), 64%
16. Leukemia-free Survival Adjusted Probability, % 12 24 60 48 36 0 Months CB matched (n=35) 60% CB 1-Ag MM >3.5x10 7 /kg (n=157) 45% BM matched (n=116) 38% CB 2-Ag MM (n=267) 33% CB 1-Ag MM <3.5x107/kg (n=44) 35% Eapen M et al Lancet. 2007, 369:1947-54 0 20 40 60 80 100
17. Comparative studies between UCBT and UBMT in adults ENGRAFTMENT ACUTE GVHD CHRONIC GVHD EARLY TRM RELAPSE SURVIVAL Rocha NEJM 2004; Laughlin NEJM 2004; SANZ Blood 2004; Takahashi Blood 2004 Cord blood vs Bone Marrow
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19. Co infusion of 2 Cord blood units Transplantation of 2 partially HLA-matched umbilical cord blood units to enhance engraftment in adults with hematologic malignancies . Barker et al. Blood 2005 ; 105:1343-1347
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25. sUCBT versus dUCBT for adults with AL Neutrophil recovery 60 50 40 30 20 10 0 1,0 ,8 ,6 ,4 ,2 0,0 87 ± 2% 86 ± 2% dUCBT sUCBT
26. sUCBT versus dUCBT for adults with AL 100 day CI of Acute GVHD II-IV days 25 ± 2% 36 ± 3% P=0.004 dUCBT sUCBT
27. 26 ± 2% 18 ± 3% P=0.06 months sUCBT versus dUCBT for adults with AL 2 years Relapse incidence dUCBT sUCBT
28. 36 ± 3% 37 ± 4% P=0.62 months sUCBT versus dUCBT for adults with AL 2 y CI of non-relapse mortality dUCBT sUCBT
29. 38 ± 3% 45 ± 3% P=0.05 months sUCBT versus dUCBT for adults with AL 2 y LFS dUCBT sUCBT
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34. Number of CBT by year reported to Eurocord Related n=596 Unrelated n=6140 Children n=3287 Adults n=2770 Unrelated CBT according to recipient age by year *Still collecting data * * Eurocord registry Data Base
35. Malignant n=4944 Non malignant n=1647 Eurocord registry Data Base
36. Double UR CBT/ year n=1080 *Still collecting data Reduced intensity Conditioning before UR CBT/year n=1516 * * Eurocord registry Data Base
