Goto, M.

Kawasugi, K.

Kodo, H.

Kozai, Y.

Noguchi, M.

Shirafuji, N.

Shirasaki, R.

Tashiro, H.

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both of which were signiﬁcantly faster than in previously published
studies. After T cell recovery, peripheral blood T cells moved from
the naive to the central memory fraction immediately, and then
moved to the effector memory fraction. A naive subset of CD4 T
cells remained (median: 38 cells/L on day 90, n  12) during the
ﬁrst 3 months, which was signiﬁcantly higher than in the BMT
control (median: 9 cells/L on day 90, n  5, p  0.015). To
investigate whether these T cells with memory phenotype are
functional, we analyzed antigen-speciﬁc T-cell recovery using cy-
tomegalovirus (CMV) as a speciﬁc antigen. CMV-responsive
CD4 T cells were detected within the ﬁrst 4 months in all
recipients with positive CMV antigenemia (n  13), but CD8 T
cells were detected only in 5 out of 13 cases. To conclude, naive
cord blood T cells rapidly increased in number and adopted a
memory phenotype showing cytokine-production and antigen-rec-
ognition capacity in the early phase after CBT. These data suggest
that mature T lymphocytes in cord blood have unique properties
and contribute to the favorable clinical outcome of CBT.
4
UMBILICAL CORD BLOOD TRANSPLANTATION AFTER A NON-MYELOA-
BLATIVE THERAPY IN HIGH RISK ADULTS AND ADOLESCENTS
Wagner, J.E., Brunstein, C., Barker, J. Blood and Marrow Transplant
Program, University of Minnesota, Minneapolis, MN
Bone marrow transplantation (BMT) in adults is associated with
a high risk of graft-versus-host disease (GVHD), opportunistic
infection and regimen related toxicity. For these reason, umbilical
cord blood (UCB) after a non myeloablative preparative regimen
has been explored. The underlying hypothesis is that umbilical
cord blood T cells will be sufﬁciently alloreactive to effect engraft-
ment in the non myeloablative setting. Fifty-one adults with ad-
vanced hematologic malignancies [median age 49 years (range
19-60)], ineligible for myeloablative conditioning by virtue of ad-
vanced age (73%), extensive prior therapy (42%) or serious co-
morbidities/poor ﬁtness (31%) received UCB transplantation
(UCBT) after cyclophosphamide 50 mg/kg, ﬂudarabine 200 mg/
m2, and 200 cGy TBI. Immunosuppression was with cyclospo-
rine-A to at least day 100 and mycophenolate mofetil to day 30.
Patients with no combination chemotherapy in the 6 months prior
to transplant also received ATG during conditioning. Approxi-
mately 1/4 received single and 3/4 received double UCB grafts.
Units were predominantly 1-2 antigen HLA mismatched with the
recipient. The incidence of sustained neutrophil engraftment of
donor origin was 89% (95% CI, 81-97) at a median of 8 days
(range 5-32). Stratiﬁed into those with and without chemotherapy
in the prior 4 months, the cumulative incidence of sustained donor
engraftment was 98% (95% CI: 94-100) and 64% (95% CI, 39-89)
(p  0.03). The incidence of platelet recovery (50,000/L) was
68% (95% CI, 53-83). The incidences of grade II-IV and grade
III-IV acute GVHD were 63% (95% CI: 49-73) and 25% (95%
CI: 14-36) at day 100, and chronic GVHD was 28% (95% CI:
16-40) at 1 year. TRM was 19% (95% CI: 9-29) at day 180.
Regression of relapsed or persistent disease has been seen in pa-
tients with myelodysplasia and intermediate and low grade lym-
phoid malignancies. The probability of overall survival at 1 year is
44% (95% CI: 30-58). Notably, only ﬁtness and not age was
associated with poor outcome. These data suggest that the regimen
is well tolerated and sufﬁcient for engraftment particularly in
patients with chemotherapy in the preceding 4 months. This ap-
proach extends access to transplant to many adults who would
otherwise be ineligible based on lack of donor and/or inability to
tolerate high-dose conditioning.
5
COMPARISON OF ADULT ALLOGENEIC UMBILICAL CORD BLOOD
TRANSPLANTATION BETWEEN MYELOABLATIVE AND NON-MYELOAB-
LATIVE CONDITIONING REGIMENS
Tashiro, H.1, Kozai, Y.2, Goto, M.1, Noguchi, M.1, Shirasaki, R.1,
Kawasugi, K.1, Kodo, H.2, Shirafuji, N.2 1. Department of Hematology/
Oncology, Teikyo University School of Medicine, Tokyo, Japan; 2. Di-
vision of Transfusion Medicine, Fuchu Metropolitan Hospital
Aim: To make clear the feasibility of non-myeloablative condi-
tioning on adult allogeneic umbilical cord blood transplantation,
we compared the result between patients receiving the myeloabla-
tive transplantation and the non-myeloablative transplantation
(NST) in point of the engraftment, and the incidence of acute
GVHD.
Patients and Methods: Patients who were underwent umbilical
cord blood transplantation during May 1999 to Mar 2005 were
analyzed retrospectively. The myeloablative group: 30 patients
(median age, 33) with AML (n 10), ALL (n 10), NHL (n 6),
MDS (n  3), and CML (n  1). Conditioning consisted of total
body irradiation (TBI)-based regimens or busulfan-based ones.
GVHD prophylaxis was with cyclosporine (CyA) alone, CyA with
short-term Methotrexate (s-MTX), or Tacrolimus with s-MTX.
NST group: 22 patients (median age, 55) with AML (n  6), ALL
(n  1), MDS (n  3), CMMoL (n  1), NHL (n  7), HD (n 
3), and CLL (n  1). Conditioning regimen consisted mostly of
TBI combined with Fludarabine. GVHD prophylaxis was with
CyA, CyA with MMF, or Tacrolimus. The median transplanted
cell number, and HLA disparity were similar between two groups.
Results: The rate of engraftment failure including conditioning
failure, and autologous recovery was 27% in the myeloablative
group and 32% in NST group, respectively. Neutrophils were
engrafted at day 23 (median) and at day 21 in the myeloablative and
NST group, respectively. The cumulative incidence of grade
III-IV acute GVHD was 26% in the myeloablative group and 40%
in NST group, respectively.
Conclusion: There were no signiﬁcant differences in the prob-
ability of engraftment and in the duration to the engraftment of
neutrophils between two groups. The incidence of grade III-IV
GVHD in NST group was higher than that in the myeloablative
group. Further observations are needed to ascertain the feasibility
of NST using allogeneic umbilical cord blood.
6
UMBILICAL CORD BLOOD (UCB) TRANSPLANTATION FOR INDOLENT
LYMPHOID MALIGNANCIES
Barker, J.N.1, Wagner, J.E.2 1. Memorial Sloan-Kettering Cancer
Center, New York, NY; 2. University of Minnesota, MN
Multiple studies have suggested patients with refractory or re-
current Non-Hodgkin’s lymphoma (NHL) can beneﬁt from allo-
geneic transplantation with reduced risk of post-transplant relapse
as compared to that seen after autologous transplantation due to a
graft-versus-lymphoma (GVL) effect. However, widespread appli-
cation of allografting has been limited by lack of suitable donors
and high transplant-related mortality (TRM) early post transplant
when conventional myeloablative conditioning is used. Non-my-
eloablative (NMA) conditioning is associated with reduced TRM
and has been successful in patients transplanted with matched
sibling donors for follicular NHL, chronic lymphocytic leukemia
(CLL), and mantle cell lymphoma (MCL). The University of
Minnesota has investigated NMA UCB transplantation (UCBT) in
patients without matched sibling donors using conditioning with
50 mg/kg Cyclophosphamide, 200 mg/m2 Fludarabine and 200
cGy TBI with cyclosporine and mycophenolate mofetil immuno-
suppression. This approach in patients with advanced hematologic
malignancies has been associated with a high incidence of sustained
donor engraftment and a low incidence of TRM despite older age
and/or extensive prior therapy provided the recipient has good
performance status. Sixteen patients aged 37-67 years with ad-
vanced or refractory follicular NHL (n 7), CLL (n 6) or MCL
(n  3) were transplanted using this approach. Thirteen had
sustained donor engraftment. Grade II–IV acute and extensive
chronic graft-versus-host disease (GVHD) was seen in 12 and 6
patients, respectively. Four patients (3 follicular NHL and 1 CLL)
have died with progressive disease and 12 are alive in complete
remission between 180 and 1214 days after transplant. Two of the
3 patients with failure of donor engraftment were salvaged with a
single cycle of CVP. This lack of intensive combination chemo-
therapy immediately prior to transplant may have contributed to
their risk for graft rejection. Two patients with follicular NHL
required the addition of Rituximab post-transplant to achieve re-
mission. Interestingly, 2 of 3 patients (both with CLL) who had
transient donor engraftment and subsequent graft rejection are in
Abstracts
929B B & M T


5. Comparison of adult allogeneic umbilical cord blood transplantation between myeloablative and non-myeloablative conditioning regimens 

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5. Comparison of adult allogeneic umbilical cord blood transplantation between myeloablative and non-myeloablative conditioning regimens

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