This document summarizes research on unrelated cord blood transplantation (UCBT) for adults with hematological malignancies. It provides updates from the Eurocord registry on over 11,000 UCBT cases. It then reviews outcomes from UCBT for specific diseases like acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and myelodysplastic syndrome (MDS). Favorable factors are identified such as disease status, age, and cell dose. Conditioning regimens and complications are also discussed. Surveys of UCBT for ALL and AML provide more detailed analyses of 2-year survival rates based on disease characteristics and transplant factors.
Ohio State's ASH Review 2017 - Myeloproliferative DisordersOSUCCC - James
Katherine Walsh, MD
Assistant Professor of Clinical Internal Medicine
The Ohio State University Comprehensive Cancer Center -
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
Ohio State's ASH Review 2017 - Myeloproliferative DisordersOSUCCC - James
Katherine Walsh, MD
Assistant Professor of Clinical Internal Medicine
The Ohio State University Comprehensive Cancer Center -
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
Ohio State's ASH Review 2017 - Benign HematologyOSUCCC - James
Spero R. Cataland, MD
Professor of Clinical Internal Medicine
The Ohio State University Comprehensive Cancer Center -
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
In this downloadable slideset, expert faculty members Andrew Carr, MBBS, MD, FRACP, FRCPA; Daniel R. Kuritzkes, MD; and Ian M. Sanne, MBBCH, FCP(SA), review key studies presented at the 2016 International AIDS Conference.
Format: Microsoft PowerPoint (.ppt)
File size: 1.28 MB
Date posted: 8/5/2016
cystatin C as an early marker of cisplatin-induced AKIد.محمود نجيب
discussion presentation for master degree in Nephrology with the title of Cystatin C as an early predictor of acute kidney injury induced by cisplatin and its analogues
Clinical Impact of New HIV Data From the 2016 Comorbidities-Adverse Drug Reac...hivlifeinfo
In this downloadable slideset, expert faculty members Todd T. Brown, MD, PhD, and Jordan E. Lake, MD, MSc, review key studies presented at the 2016 Comorbidities/Adverse Drug Reactions Workshop.
Format: Microsoft PowerPoint (.ppt)
File size: 1.37 MB
Date posted: 10/14/2016
Remote Access to Windows Remote Desktop Servers in a new DimensionHOB
Looking for a highly performant and easy to manage RDP-Client for remote access? Don´t miss this e-book and find out what makes HOBLink JWT so special!
CAH has worked with front-line organizations in Estonia, Mozambique and South Africa to prepare analytic case studies of three outstanding initiatives that have scaled up the provision of health services to adolescents. The South African case study is of the Evolution of the National Adolescent Friendly Clinic Initiative which was an integral part of the high profile loveLife programme. The Mozambican case study was of the progress made by the multisectoral Geraçao Biz programme, a key component of which was youth-friendly health services, in moving from inception to large scale. The Estonian case study was that of the nationwide spread of the Amor youth clinic network, led by the Sexual Health Association in that country.
Ohio State's ASH Review 2017 - Benign HematologyOSUCCC - James
Spero R. Cataland, MD
Professor of Clinical Internal Medicine
The Ohio State University Comprehensive Cancer Center -
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
In this downloadable slideset, expert faculty members Andrew Carr, MBBS, MD, FRACP, FRCPA; Daniel R. Kuritzkes, MD; and Ian M. Sanne, MBBCH, FCP(SA), review key studies presented at the 2016 International AIDS Conference.
Format: Microsoft PowerPoint (.ppt)
File size: 1.28 MB
Date posted: 8/5/2016
cystatin C as an early marker of cisplatin-induced AKIد.محمود نجيب
discussion presentation for master degree in Nephrology with the title of Cystatin C as an early predictor of acute kidney injury induced by cisplatin and its analogues
Clinical Impact of New HIV Data From the 2016 Comorbidities-Adverse Drug Reac...hivlifeinfo
In this downloadable slideset, expert faculty members Todd T. Brown, MD, PhD, and Jordan E. Lake, MD, MSc, review key studies presented at the 2016 Comorbidities/Adverse Drug Reactions Workshop.
Format: Microsoft PowerPoint (.ppt)
File size: 1.37 MB
Date posted: 10/14/2016
Remote Access to Windows Remote Desktop Servers in a new DimensionHOB
Looking for a highly performant and easy to manage RDP-Client for remote access? Don´t miss this e-book and find out what makes HOBLink JWT so special!
CAH has worked with front-line organizations in Estonia, Mozambique and South Africa to prepare analytic case studies of three outstanding initiatives that have scaled up the provision of health services to adolescents. The South African case study is of the Evolution of the National Adolescent Friendly Clinic Initiative which was an integral part of the high profile loveLife programme. The Mozambican case study was of the progress made by the multisectoral Geraçao Biz programme, a key component of which was youth-friendly health services, in moving from inception to large scale. The Estonian case study was that of the nationwide spread of the Amor youth clinic network, led by the Sexual Health Association in that country.
We examine the sources and micro-level mechanisms of the changes in the labor share of value added. We link the micro-level dynamics of the labor share change with that of productivity and wage growth. Using a useful variant of the decomposition method we make a distinction between the change in the average plant and the micro-level restructuring. With Finnish plant-level data covering three decades we show that micro-level restructuring is the link between the declining labor share and increasing productivity in 12 manufacturing industries of four regions, and that increased international trade is a factor underlying those shifts.
Developing competencies for occupational therapy education and practiceErganen
A presentation on developing competencies for occupational therapist including; what are competencies, why are they important and how to develop competencies. In the end there are references for further resources
La información es uno de los activos potencialmente más valiosos para una empresa. “La información es poder” dijo Sir Francis Bacón en el s.XVI. Sin embargo, el valor real de la información depende de cómo gestionarla, analizarla e interpretarla. Si no se realiza correctamente, haremos realidad la frase del filósofo George Steiner: “Nunca como ahora ha habido más información y menos conocimiento”
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Современное лечение ВИЧ.Обобощенные данные с конференции CROI 2020 / Contemporary Management of HIV.Integrating New Data From CROI 2020
Широкий спектр вопросов, включая стратегии АРТ на поздних стадихя заболевания, менеджмент ожирения, метаболические исходы АРТ, данные по АРТ во время беременности и пр
Format: Microsoft PowerPoint (.ppt)
File Size: 554 KB
Released: April 14, 2020
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Unrelated Cord Blood Transplantation In Adults with Hematological Malignancies Eurocord Results
1. Vanderson Rocha, MD, PhD
Professor of Haematology- Oxford University
BMT unit, Churchill Hospital
Oxford, UK
Scientific Director of Eurocord
Paris, France
Unrelated Cord Blood Transplantation
In adults with Hematological Malignancies
Eurocord Results
2. UCBT for adults with Malignancies
• Eurocord Registry update
• Indications
• Survey on outcomes for specific diseases
• Survey on outcomes of elderly patients in Europe and USA
• Conditioning regimen
• Complications (engraftment)
3. UCBT for adults with Malignancies
• Eurocord Registry update
• Indications
• Survey on outcomes for specific diseases
• Survey on outcomes of elderly patients in Europe and USA
• Conditioning regimen
• Complications (engraftment)
4. Eurocord Registry Update
• 12.066 CBU shipped for transplantation (283, 2%, not used):
11.783 CBU used for:
• 9.883 CBT from 1988 to 2012 in 51 countries and 577 centres
293 EBMT 6958 cases (75%)
267 Non-EBMT 2379 cases (25%)
54%
46%
Children n=5071 (54%)
Adult n=4265 (46%)
8%
92%
Related n=708 (8%)
Unrelated n=8618 (92%)
5. Eurocord Registry
N°of European CBUs shipped by year*
* 215 CBUs not infused are included in the bar chart
0
100
200
300
400
500
600
700
800
900
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Year of
shipment
N of
CBUs
1990 3
1991 1
1992 2
1993 1
1994 5
1995 15
1996 30
1997 58
1998 92
1999 123
2000 145
2001 192
2002 167
2003 187
2004 298
2005 440
2006 590
2007 695
2008 823
2009 813
2010 878
2011 817
2012 813
N=7188
6. Eurocord Registry
Unrelated European CBT by recipient’s age and graft type
Children Adults
* Still collecting 2012 data
0
50
100
150
200
250
300
1990
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Double CBT
Single CBT
*
0
50
100
150
200
250
300
350
400
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Double CBT
Single CBT *
In children: 92% single CBT In adults: 47% double CBT
8. Children, n=2354 Adult, n=1337
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
TNC (x10^7) of CBU Used for Single Transplants
9. UCBT for adults with Malignancies
• Eurocord Registry update
• Indications
• Survey on outcomes for specific diseases
• Survey on outcomes of elderly patients in Europe and USA
• Conditioning regimen
• Complications (engraftment)
11. Age distribution for adult patients
0 200 400 600 800 1000 1200
16- 30 y
30- 39 y
40- 49 y
50- 59 y
>60 y
1103
736
790
752
433
N=1185
12. UCBT for adults with Malignancies
• Eurocord Registry update
• Indications
• Survey on outcomes for specific diseases
• Survey on outcomes of elderly patients in Europe and USA
• Conditioning regimen
• Complications (engraftment)
14. 2 Years Survival in Adults (single and double unrelated CBT)
with Acute Leukemia (n=1552) by disease status
CR1 (n= 636)- 48%
CR2 (n= 557)- 41%
More advanced (n= 359)-12%
16. Clinical Results of Unrelated CBT in Adults
n Median
FU (m/y)
Outcomes Favourable Risk
Factors
Ref
Lymphoid
malignancies
104 18 m DFS: 41% Chemosensitive disease
Low-dose TBI
Cell dose>2x107/Kg
JCO, 2009
MDS
108 25 m DFS: 30% low-risk disease Leukemia,
2010
Acute leukemia-
KIR
218 14 m LFS:
KIR-MM: 55%
KIR-M: 31%
KIR-ligand incompatibility
HLA 0/1 mismatch
Leukemia
2009
Acute leukemia-
RIC
155 18 m LFS: 51% Disease Status
HLA 0/1 mismatch
Not
published
ALL 421 24 m LFS
CR1: 39%
CR2: 31%
Adv: 8%
Disease Status, age<35
No use of ATG
Submitted
2013
AML 604 24 m LFS:
CR1: 43%
CR2: 38%
Adv: 11%
Disease Status, no previous
autologous transplant, TBF
(MAC)
Disease status, age<48 years
Not
published
17. Clinical Results of Unrelated CBT in Adults
n Median
FU (m/y)
Outcomes Favourable Risk
Factors
Ref
Lymphoid
malignancies
104 18 m DFS: 41% Chemosensitive disease
Low-dose TBI
Cell dose>2x107/Kg
JCO, 2009
MDS
108 25 m DFS: 30% low-risk disease Leukemia,
2010
Acute leukemia-
KIR
218 14 m LFS:
KIR-MM: 55%
KIR-M: 31%
KIR-ligand incompatibility
HLA 0/1 mismatch
Leukemia
2009
Acute leukemia-
RIC
155 18 m LFS: 51% Disease Status
HLA 0/1 mismatch
Not
published
ALL 421 24 m LFS
CR1: 39%
CR2: 31%
Adv: 8%
Disease Status, age<35
No use of ATG
Submitted
2013
AML 604 24 m LFS:
CR1: 43%
CR2: 38%
Adv: 11%
Disease Status, no previous
autologous transplant, TBF
(MAC)
Disease status, age<48 years
Not
published
18. Outcomes of unrelated cord blood transplant
for adults with acute lymphoblastic
leukemia: a survey conducted by Eurocord
and the ALWP/EBMT
L Tucunduva, A Ruggeri , G Sanz, S Furst, B Rio, G Socié, W Arcese, M
Michallet, I Yakoub-Agha, J Cornelissen, J Sanz, P Montesinos, D Purtill, E
Gluckman, M Mohty and V Rocha
BMT Tandem Meetings CIBMTR / ASBMT
Salt Lake City 13-17 February/2013
No conflict of interest to disclose
19. Patient and disease characteristics n=421
Characteristics
CR1,
n=195
CR2,
n= 136
Not CR
n= 90
Median age at UCBT, years (range) 35 (18-64) 26 (18-76) 30 (18-60)
Age ≥35 years at diagnosis 48% 25% 31%
Immunophenotype
B 71% 74% 63%
T 20% 21% 35%
Other 9% 5% 2%
WBC count at diagnosis
median (range) 16 (0.6-456) 11 (0.2-624) 13 (0.7-515)
≥30x109
/L 40% 32% 39%
≥100x109
/L 14% 14% 24%
Cytogenetics
very high risk 57% 23% 28%
high risk 5% 2% 8%
standard risk 38% 75% 63%
Median time from diagnosis to UCBT,
months (range)
7 (3-39) 31 (2-96) 16 (3-113)
Median time from diagnosis to first
relapse, months (range) na 27 (3-140) 13 (2-138)
20. Transplant characteristics
Characteristics
CR1,
n=195
CR2,
n= 136
Not CR
n= 90
Type of UCB graft
single 57% 54% 70%
double 43% 46% 30%
TNC x107
/Kg; median (range) 4.0 (1.8-9.4) 4.1 (1.5-9.0) 3.8 (1.8-9.2)
HLA matching
No mismatch 4% 1% 0%
1 mismatch 32% 23% 26%
2-3 mismatches 64% 76% 74%
Type of conditioning
RIC 28% 24% 18%
MAC 72% 76% 82%
23. Results - 2y LFS all patients
CR1 39±4%(n=195)
CR2 31±4% (n=136)
not in CR 8±3% (n=90)
p<0.0001
24. Results - 2y LFS all patients
no ATG 42±4% (n=132)
ATG 23±3% (n=239)
p<0.0001
25. Results - 2y LFS
MAC RIC
no ATG 39±6% (n=72)
ATG 23±3% (n=212)
no ATG 47±6% (n=62)
ATG 33±10% (n=25)
p=0.02 p=0.04
26. Multivariate analysis for LFS
• Variables tested in the model:
-- age (≥35 vs <35 years)
-- remission status (CR1 and CR2 vs advanced)
-- median collected TNC (equal or superior vs inferior 4.0x107/kg)
-- conditioning (RIC vs MAC)
-- type of graft (single vs double)
-- use of ATG in conditioning regimen (yes vs no)
Variable HR 95% IC p value
age ≥35 y 1.3 1.1-1.7 0.03
not in CR at UCBT 2.5 2.0-3.3 <0.0001
ATG 1.5 1.1-2.0 0.009
Factors associated with decreased LFS
27. Clinical Results of Unrelated CBT in Adults
n Median
FU (m/y)
Outcomes Favourable Risk
Factors
Ref
Lymphoid
malignancies
104 18 m DFS: 41% Chemosensitive disease
Low-dose TBI
Cell dose>2x107/Kg
JCO, 2009
MDS
108 25 m DFS: 30% low-risk disease Leukemia,
2010
Acute leukemia-
KIR
218 14 m LFS:
KIR-MM: 55%
KIR-M: 31%
KIR-ligand incompatibility
HLA 0/1 mismatch
Leukemia
2009
Acute leukemia-
RIC
155 18 m LFS: 51% Disease Status
HLA 0/1 mismatch
Not
published
ALL 421 24 m LFS
CR1: 39%
CR2: 31%
Adv: 8%
Disease Status, age<35
No use of ATG
Submitted
2013
AML 604 24 m LFS:
CR1: 43%
CR2: 38%
Adv: 11%
Disease Status, no previous
autologous transplant, TBF
(MAC)
Disease status, age<48 years
Not
published
28. Cord blood transplantation for adult
with acute myeloid leukaemia:
a survey on behalf of Eurocord and ALWP-EBMT
Annalisa Ruggeri, William Arcese, Guillermo Sanz, Bernard Rio,
Noel Milpied, Sabine Furst, Josep Ribera, Alberto Bosi, Emmanouel Nikiforakis,
Eliane Gluckman, Mohamad Mohty, Myriam Labopin and Vanderson Rocha
16th Congress of the European Hematology Association (EHA)
London - 11/06/2011
No conflict of interest to disclose
29. UCBT for AML
Patients and disease characteristics, n= 604
60% single and 40% adults
CR1, n=229 CR>=2, n=228 Adv, n=147
Median age at UCBT (years) 40 (18-66) 42 (18-68) 41 (22-67)
Male 109 (49%) 109 (48%) 71 (48%)
Positive pts CMV serology 130 (63%) 133 (64%) 74 (64%)
High risk cytogenetic n=192 n=190 n=114
115 (60%) 94 (49%) 63 (55%)
Interval diagnosis-UCBT 6 months 22 months 13 months
Previous HSCT (auto/allo) 12 (5%) 77 (34%) 44 (32%)
Median Follow-up 24 (range 3-120) months
30. UCBT for AML
Transplant characteristics, n=604
• MAC • RIC
MAC: TBI dose > 6Gy, Busulfan dose >8 mg/Kg or IV BU>9.6 mg/kg
CyFluTBI-
2Gy
72%
Other Flu-
Based
15%
Other
13%BuFluTT
34%
BuCy
10%BuCyTT
5%
CYTBI-12Gy
16%
CyFluTBI-
12Gy
11%
Other Bu-
Based
12%
Other
12%
31. UCBT for AML- MAC
LFS
MAC- 2y LFS by disease status, n=293
Disease Status
(Remission)
HR 2,11- 95%CI 1,56- 2,87, p=<0,0001
No Previous HSCT HR 2,19 -95%CI 1,58- 3,04, p=<0,0001
Multivariate analysis (LFS- MAC)
CR1: 51%
CR2 and CR3:37%
Adv: 14%
p<0.0001
33. UCBT for adults with Malignancies
• Eurocord Registry update
• Indications
• Survey on outcomes for specific diseases
• Survey on outcomes of elderly patients in Europe and USA
• Conditioning regimen
• Complications (engraftment)
34. Changing trends of UCBT for hematological malignancies
in patients older than 50 years:
a Eurocord- CIBMTR survey
Annalisa Ruggeri, Mary Eapen,
Luciana Tucunduva, Fernanda Volt, Mary Horowitz,
Vanderson Rocha, Daniel Weisdorf and Eliane Gluckman
No conflict of interest to disclose
36. Single and double UCBT:
distribution of age for adult patients
0 200 400 600 800 1000 1200
16- 30 y
30- 39 y
40- 49 y
50- 59 y
>60 y
1171
780
719
805
477
1103
736
790
752
433
Eurocord
CIBMTR
37. Study Objective
Survey of patients more than 50 years of age
reported to Eurocord and CIBMTR
• Period 2005 - 2011
• Hematologic malignancies
N = 1529
n = 848 (N. America)
n= 681 (Europe)
Median follow up:
24 months 0
100
200
300
400
500
600
50- 59 y 60- 69 y 70+ y
Eurocord
CIBMTR
64%
36%
60%
37%
3%
Age distribution
42. Overall Survival
-AML by disease status and conditioning-
Eurocord, n=257
46±4%
33±10%
30±12%
6±4%
■ CR and MAC, n=29
■ CR and RIC, n=176
■ Rel and MAC, n=17
■ Rel and RIC, n=35
43. Overall Survival
- Acute Myeloid Leukemia –
Probability,%
Years
0
100
0
20
40
60
80
90
10
30
50
70
0
100
20
40
60
80
90
10
30
50
70
1 2
CR and MAC (N=112)
CR and RIC (N=191)
Rel and MAC (N=49)
Rel and RIC (N=31)
CIBMTR, n=373
46. UCBT for adults with Malignancies
• Eurocord Registry update
• Indications
• Survey on outcomes for specific diseases
• Survey on outcomes of elderly patients in Europe and USA
• Conditioning regimen
• Complications (engraftment)
48. No Flu Based (n=1471) 86 %
Fludarabine based MAC (n=384) 91%
6050403020100
1,0
,8
,6
,4
,2
0,0
Neutrophil recovery after single UCBT for patients with malignant
disorders after myeloablative conditioning regimen (n=1946)
p< 0.0001
49. Conditioning regimen
Myeloablative
Analyze the impact of TT, iv BU, F+ATG (TBF-ATG) on long
term outcomes after single unit UCBT compared to other
MAC regimens in adults with leukemias in remission
H Bittencourt et al. # 377, Oral session EBMT
51. Early Stage (n=147)
Characteristics
Group 1, sUCBT
Cy-based
n=93
Group 2, sUCBT
Bu+Flu+TT
n=54
Age (years) 33(18-54) 32 (19-51)
HLA match – 4/6 51(56%) 28(53%)
Acute Leukemia* 79(85%) 52 (96%)
Median TNC after thawing
(107
Kg)
2.5 (0.6-7.6) 2.3 (1.4-4.9)
GVHD Prophylaxis:
CSA+Steroids
ATG
78(84%)
83(89%)
38 (70%)
48(89%)
Year of UCBT* 2003 (2000-2007) 2006 (2005-2008)
* P<0.05
Besides ABO major incompatibility (P=0.02), there was no other differences among the 2 groups for patients disease and UCBT
characteristics (gender, weight, CMV status, previous autologous HSCT, CD34+ infused cells)
52. EFS at 5 years
Early Stage
Group 1: sUCBT-Cy-based: 28%
Group 2: sUCBT-BuFluTT: 41%
BuFluTT associated with better event-free survival in multivariate analysis
HR 0.64 (CI95%:0.41-0.99 – P=0.04)
P=0.07
DFS: 32%
54. p=0.03
Group 1: sUCBT-CyTBI12: 30±7%, n=68 (Cell dose 2.9)
Group 2: sUCBT-BuFluTT+ATG: 46±6%, n=88 (Cell dose 3.1)
Group 3: dUCBT-CyFluTBI12: 48±6%, n=83 (Cell dose 3.7)
LFS at 2 years
MAC sUCBT and dUCBT in adults with AL in CR1
56. Disease Free Survival according to conditioning
after single and double UCBT for malignancies in
adults ( n=155)
Months
28% others
51% CY+TBI 2GY+FLU (n=101)
P= 0.0002
57. 0 10 20 30
0.00.20.40.60.81.0
Months
Probability Relapse
2 year estimate: 46%
Phase II trial in France on the use of TCF–RIC in UCBT for
AML ( n=79)
Cumulative Incidence of Relapse
Rio B et al
Should we include Thiotepa or increase TBI
in the RIC ?
58. UCBT for adults with Malignancies
• Eurocord Registry update
• Indications
• Survey on outcomes for specific diseases
• Survey on outcomes of elderly patients in Europe and USA
• Conditioning regimen
• Complications (engraftment)
59. PROBABILITY OF ENGRAFTMENT
• The Probability Density to engraft describes the
probability to engraft at each time point from CBT, also
considering competing events (ie early deaths)
• The engraftment probability peaks at +21, the median
halves at +31 (20%) and drops to 5% at day 42
-0.0050
0.0000
0.0050
0.0100
0.0150
0.0200
0.0250
0.0300
0.0350
0.0400
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90
20% 5%
The area under the
curve beyond each
time points represents
the residual probability
to engraft
60.
61. Conclusions
Single and unrelated cord blood with myeloablative or
reduced intensity conditioning regimens are feasible
procedures and have extented the use of allo transplants
for patients without a HLA matched donor
Graft failure and delayed neutrophil recovery are still
problems to be circumvent in the field of UCBT
Analysis of risk factors in specific diseases are important with
the aim to improve final outcomes.