TY - JOUR
T1 - Cord-blood engraftment with ex vivo mesenchymal-cell coculture
AU - De Lima, Marcos
AU - McNiece, Ian
AU - Robinson, Simon N.
AU - Munsell, Mark
AU - Eapen, Mary
AU - Horowitz, Mary
AU - Alousi, Amin
AU - Saliba, Rima
AU - McMannis, John D.
AU - Kaur, Indreshpal
AU - Kebriaei, Partow
AU - Parmar, Simrit
AU - Popat, Uday
AU - Hosing, Chitra
AU - Champlin, Richard
AU - Bollard, Catherine
AU - Molldrem, Jeffrey J.
AU - Jones, Roy B.
AU - Nieto, Yago
AU - Andersson, Borje S.
AU - Shah, Nina
AU - Oran, Betul
AU - Cooper, Laurence J.N.
AU - Worth, Laura
AU - Qazilbash, Muzaffar H.
AU - Korbling, Martin
AU - Rondon, Gabriela
AU - Ciurea, Stefan
AU - Bosque, Doyle
AU - Maewal, Ila
AU - Simmons, Paul J.
AU - Shpall, Elizabeth J.
PY - 2012/12/13
Y1 - 2012/12/13
N2 - BACKGROUND: Poor engraftment due to low cell doses restricts the usefulness of umbilical-cordblood transplantation. We hypothesized that engraftment would be improved by transplanting cord blood that was expanded ex vivo with mesenchymal stromal cells. METHODS: We studied engraftment results in 31 adults with hematologic cancers who received transplants of 2 cord-blood units, 1 of which contained cord blood that was expanded ex vivo in cocultures with allogeneic mesenchymal stromal cells. The results in these patients were compared with those in 80 historical controls who received 2 units of unmanipulated cord blood. RESULTS: Coculture with mesenchymal stromal cells led to an expansion of total nucleated cells by a median factor of 12.2 and of CD34+ cells by a median factor of 30.1. With transplantation of 1 unit each of expanded and unmanipulated cord blood, patients received a median of 8.34×107 total nucleated cells per kilogram of body weight and 1.81×106 CD34+ cells per kilogram - doses higher than in our previous transplantations of 2 units of unmanipulated cord blood. In patients in whom engraftment occurred, the median time to neutrophil engraftment was 15 days in the recipients of expanded cord blood, as compared with 24 days in controls who received unmanipulated cord blood only (P<0.001); the median time to platelet engraftment was 42 days and 49 days, respectively (P = 0.03). On day 26, the cumulative incidence of neutrophil engraftment was 88% with expansion versus 53% without expansion (P<0.001); on day 60, the cumulative incidence of platelet engraftment was 71% and 31%, respectively (P<0.001). CONCLUSIONS: Transplantation of cord-blood cells expanded with mesenchymal stromal cells appeared to be safe and effective. Expanded cord blood in combination with unmanipulated cord blood significantly improved engraftment, as compared with unmanipulated cord blood only. (Funded by the National Cancer Institute and others; ClinicalTrials.gov number, NCT00498316).
AB - BACKGROUND: Poor engraftment due to low cell doses restricts the usefulness of umbilical-cordblood transplantation. We hypothesized that engraftment would be improved by transplanting cord blood that was expanded ex vivo with mesenchymal stromal cells. METHODS: We studied engraftment results in 31 adults with hematologic cancers who received transplants of 2 cord-blood units, 1 of which contained cord blood that was expanded ex vivo in cocultures with allogeneic mesenchymal stromal cells. The results in these patients were compared with those in 80 historical controls who received 2 units of unmanipulated cord blood. RESULTS: Coculture with mesenchymal stromal cells led to an expansion of total nucleated cells by a median factor of 12.2 and of CD34+ cells by a median factor of 30.1. With transplantation of 1 unit each of expanded and unmanipulated cord blood, patients received a median of 8.34×107 total nucleated cells per kilogram of body weight and 1.81×106 CD34+ cells per kilogram - doses higher than in our previous transplantations of 2 units of unmanipulated cord blood. In patients in whom engraftment occurred, the median time to neutrophil engraftment was 15 days in the recipients of expanded cord blood, as compared with 24 days in controls who received unmanipulated cord blood only (P<0.001); the median time to platelet engraftment was 42 days and 49 days, respectively (P = 0.03). On day 26, the cumulative incidence of neutrophil engraftment was 88% with expansion versus 53% without expansion (P<0.001); on day 60, the cumulative incidence of platelet engraftment was 71% and 31%, respectively (P<0.001). CONCLUSIONS: Transplantation of cord-blood cells expanded with mesenchymal stromal cells appeared to be safe and effective. Expanded cord blood in combination with unmanipulated cord blood significantly improved engraftment, as compared with unmanipulated cord blood only. (Funded by the National Cancer Institute and others; ClinicalTrials.gov number, NCT00498316).
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U2 - 10.1056/NEJMoa1207285
DO - 10.1056/NEJMoa1207285
M3 - Article
C2 - 23234514
AN - SCOPUS:84871071832
SN - 0028-4793
VL - 367
SP - 2305
EP - 2315
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 24
ER -