Evaluation of the Affect of Maternal and Neonatal Factors on Cord Blood Parameters?
AbstractBackground: Chronic graft versus host disease (cGVHD) is one of the most serious potential complications of allogeneic bone marrow transplantation.
Study design and method: We analyzed the incidence of cGVHD and its associated risk factors in a group of 161 Iranian recipients of HLA-identical sibling transplants, with at least 90 days post-transplantation survival. In the majority of cases (n=73), cGVHD occurred in the first year after the transplant (median 273 days). The actual probability of cGVHD within 1 year was 45.3±7% (CI 95%).
Results: In a univariate analysis, the most important risk factor was the type of transplant. Peripheral blood stem cell transplants (PBSCT) showed a significant increase in cGVHD compared with bone marrow transplants (BMT) (RR=2.34, p<0.001). In addition, male recipients were at a greater risk than female recipients (RR=2.08, p=0.004). Other risk factors were the presence of prior acute GVHD (RR=2.37, p=0.04) and the previous acute GVHD grade (p=0.03); The probabilities of cGVHD in patients with grade 0, Ι, ΙІ, ΙΙΙ, ΙV acute GVHD were 24%, 44.7%, 42.6%, m56.8%, 64.3%, respectively.
Conclusion: In a multivariate analysis, the only independent predictive factors for the development of cGVHD were the type of transplant (PBSC>BM, p<0.001) and male recipient (p=0.005). The survival rate was 88.8% and there was no significant difference in the probability of survival between BPSCT vs BMT (93.8% vs 86.6%, p=0.5).
- Goldman JM, Schmitz N, Niethammer D, et al. Allogeneic and autologous transplantation for human, solid tumors and immune disorders. Current practice in Europe in 1998. BMT. 1998. 21: 1-7.
- Gluckman E, Rocha V, Chnstang C, Cord blood banking and transplant in Europe. BMT 1998; 22 (suppl 1):568-574.
- Gluckman E, Broxmeyer HE, Auerbach AD, et al, Hematopoitic reconstitution in a patient with Fanconi anemia by means of umbilical cord blood from an HLA-identical sibling. N Engl J Med 1989; 321:1174-8.
- Newberger P, Queseenbery P, Umbilical cord blood as a new and promising source of unrelated- donor hematopoietic stem cells for transplantation. I curr opin pediat 1996; 8: 29-32.
- Rubinstein P, Carrier C, Scaradavou A et al, Outcomes among 562 recipients of placental blood transplants from unrelated donors. N Engl J Med 1998; 339: 1565-77.
- Cohen S, Dominguez E, Lowd ell M, Madrigal J. The immunological properties of cord blood overview of current research presented at 2nd Euro cord workshop. Bone marrow transplant 1998; 22 (suppl 1):522- 5.
- Rabian- Herzog C, Lesage S, Gluckman E, Characterization of lymphocyte subpopulations in cord blood. Bone marrow transplant 1992; 9 (suppl 1): 64-7.
- Varadi G, Elchalal U, Brautbar C, Nagler A, Human umbilical cord blood for hematopoietic progenitor cells transplantation. J Leuk Lymphoma 1995; 20: 51- 8.
- Wagner JE, Kurtzberg J, Cord blood stem cells. Curropin Hematol 1997; 4: 413- 18.
- Glukman E, Rocha V, Boyer-chamard A. et al. Outcome of cord blood transplantation from related and unrelated donors. New Engl J med 1997; 337- 3379.
- Kogler G, Callejas J, Sorg RV et al. Effect of different thawing methods, growth factor combinations media on the ex vivo expansion of umbilical cord blood primitive committed progenitors, BMT (1998) 21, 233-241.
- Sierra J, Storer B, Hansen AJ. et al, Transplantation of marrow cells from unrelated donors for treatment of high-risk acute leukemia: the effect of leukemic burden, donor HLA- matching and marrow cell dose. Blood 1997; 89: 4226-35.
- Kogler G, Callejas J, Hakenberg P et al. Hemato- poietic transplantation potential of unrelated cord blood: critical issues. J Hemat other 1996; 5: 105-116.
- Turner CW, Luzins J, Hutucheson C. A modified harrest technique for cord blood hematopoietic stem cells. Bone marrow transplant 1997; 10: 89.
- Harris DT, Schumacher MJ, Rychlik S et al. Collection, separation and cryopreservation of umbilical cord blood for use in transplantation. Bone marrow transplant 1994; 13: 135-43.
- Rubinstein P, Dobrila L, Rosenfild RE et al. processing and cryopreservation of placental umbilical cord blood for unrerated bone marrow reconstitution. Proc Natl Acad sci USA. 1995; 92; 10119-10122.
- Cohen S, Glukman E,Rubinstein P, Madrigal J, Cord blood characteristic Role in stem cell transplanta- tion 2000 Martin Dunitz Ltd London Protocol courtesy of thermo Genesis corp page 136
- Liu J, Li K, Yuen P et al. Ex vivo expansion of enriched CD34+ cells from neonatal blood in the presence of thrombopoietin, a comparison with cord blood and bone marrow, BMT, 1999,2A, 247-252.
- Piacibllo W, Sanavio F, Garetto L et al. Extensive Amplification and self-Renewal of human primitiove hematopoietic stem cells from cord blood. Blood 1997: 98; 8-2644-2653
- Watson L, Umbilical cord blood, a proven life- saver is alternative to bone marrow transplant.Adv Med Technol 1990;2(10): 1-3.
- Corliss J, umbilical cord blood may be life line for some patients. J Nat cancer inst 1993; 85: 1107- 8.
- Thompson C. umbilical cords: turning garbage into clinical gold. Science 1995; 268: 805-6.
- Sparrow RL, Cauchi JA, Ramadi LT, Waugh CM, Kirkland MA. Inflluence of mode of birth and collection on WBC yields of umbilical cord blood units. Transfusion 2002 feb; 42(2): 210-5.
- Ballen KK, Wilson M, Wuu J et al. Bigger is better: maternal and neonatal predictors of hematopoi- etic potential of umbilical cord blood units. Bone marrow transplant 2001; 27(1): 7-14.
- Kogler G, Sarnowski A, Wernet P. Volume reduction of cord blood by Hetastarch for long-term stem cell banking. Bone marrow transplant 1998; 22 Suppl 1: S14-5