Berger, Massimo

Cilloni, Daniela

De Gobbi, Marco

Fagioli, Franca

Frassoni, F.

Nicoli, Paolo

Ruatta, Celeste

Saglio, Francesco

English

DE GOBBI, Marco

Institutional Research Information System University of Turin

	  	  	  	  This	  is	  an	  author	  version	  of	  the	  contribution	  published	  on:	  Questa	  è	  la	  versione	  dell’autore	  dell’opera:	  	  [Bone	  Marrow	  Transplant.	  2015	  Volume	  50,	  Issue	  S1,	  	  Pages:	  S471-­‐S471,	  Meeting	  Abstract:	  P706	  (March	  2015)]	  	  	  The	  definitive	  version	  is	  available	  at:	  La	  versione	  definitiva	  è	  disponibile	  alla	  URL:	  http://www.nature.com.offcampus.dam.unito.it/bmt/journal/v50/n1s/index.html	  	  Intra-­‐bone	  cord	  blood	  injection	  is	  associated	  with	  improved	  platelet	  engraftment	  compared	  to	  intravenous	  cord	  blood	  hematopoietic	  stem	  cell	  transplantation	  both	  in	  adult	  and	  pediatric	  patients	  	  F.	  Saglio1,*,	  C.	  Ruatta2	  ,	  P.	  Nicoli2	  ,	  M.	  Berger1	  ,	  M.	  De	  Gobbi2	  ,	  F.	  Frassoni3	  ,	  D.	  Cilloni2	  ,	  F.	  Fagioli1	  	  	  1	  Pediatric	  Onco-­‐Hematology,	  Regina	  Margherita	  Children	  Hospital,	  AOU	  Citta`	  della	  Salute	  e	  della	  Scienza	  di	  Torino,	  2	  Division	  of	  Hematology	  and	  Internal	  Medicine,	  Department	  of	  Clinical	  and	  Biological	  Sciences,	  University	  of	  Turin,	  Turin,	  3	  IRCCS	  "Giannina	  Gaslini",	  Genoa,	  Italy	  	  Introduction	  Cord	  blood	  hematopoietic	  stem	  cell	  transplantation	  (CBHSCT)	  is	  one	  of	  the	  therapeutic	  options	  suitable	  for	  patients	  who	  need	  hematopoietic	  stem	  cell	  transplantation	  but	  who	  lack	  both	  an	  HLA	  identical	  siblings	  and	  an	  unrelated	  HLA	  matched	  adult	  stem	  cell	  donor.	  One	  of	  the	  main	  weaknesses	  of	  CBHSCT	  is	  a	  delayed	  neutrophil	  and	  platelet	  engraftment	  that	  is	  reported	  as	  one	  of	  the	  causes	  of	  the	  increased	  risk	  of	  transplant	  related	  mortality	  of	  this	  kind	  of	  transplantation.	  Some	  experimental	  clinical	  trials	  carried	  out	  both	  in	  adult	  and	  pediatric	  population	  have	  suggested	  that	  by	  direct	  intra-­‐bone	  injection	  of	  the	  cord	  blood	  unit	  (IBCBT)	  it	  is	  possible	  to	  improve	  the	  engraftment	  rate	  but	  studies	  directly	  comparing	  IBCBT	  and	  intravenous	  CBHSCT	  are	  still	  missing.	  	  	  Materials	  (or	  patients)	  and	  methods	  Between	  December	  2007	  and	  April	  2014,	  37	  patients	  aged	  from	  1	  to	  71	  years	  (median	  age	  8	  years,	  median	  weight	  23	  kg)	  underwent	  CBHSCT	  at	  our	  Centers:	  18	  had	  IBCBT	  while	  19	  had	  intravenous	  CBHSCT.	  In	  order	  to	  explore	  if	  direct	  intra-­‐bone	  injection	  of	  cord	  blood	  derived	  hematopoietic	  stem	  cells	  was	  associated	  with	  a	  faster	  neutrophil	  (PMN)	  and	  platelet	  (PLT)	  recovery	  we	  retrospectively	  compared	  the	  cumulative	  incidence	  of	  PMN	  and	  PLT	  recovery	  in	  the	  two	  groups.	  In	  the	  same	  study	  population	  we	  also	  analyzed	  the	  impact	  of	  variables	  that	  have	  been	  previously	  reported	  as	  important	  factors	  in	  determining	  CBHSCT	  outcome,	  as	  recipient’s	  age	  and	  weight,	  Total	  Nucleated	  Cell	  dose,	  CD34	  þ	  cell	  dose,	  and	  number	  of	  HLA	  mismatches	  in	  the	  donor-­‐recipient	  couple.	  	  	  Results	  We	  first	  evaluated	  in	  the	  entire	  study	  population	  (n¼	  37)	  if	  younger	  age	  was	  associated	  with	  an	  improved	  PMN	  and	  PLT	  engraftment	  but	  surprisingly	  we	  didn’t	  find	  any	  statistically	  significant	  difference	  (P¼	  0,35	  and	  P¼	  0,68	  respectively).	  We	  didn’t	  highlight	  a	  correlation	  between	  PMN	  and	  PLT	  engraftment	  and	  recipient’s	  weight	  either	  (P¼	  0,2	  and	  P¼	  0,8	  respectively).	  Considering	  PMN	  we	  didn’t	  observe	  any	  difference	  between	  engraftment	  rate	  of	  patients	  treated	  by	  IBCBT	  and	  that	  of	  patients	  treated	  by	  intravenous	  CBHSCT	  at	  any	  time	  point.	  At	  dayþ	  100,	  cumulative	  incidence	  of	  PLT	  recovery	  was	  67%	  (CI95%	  48-­‐92)	  for	  patients	  undergone	  IBCBT	  versus	  45%	  (CI	  95%28-­‐73)	  for	  patients	  undergone	  intravenous	  CBHSCT	  (P¼	  0,18).	  Extending	  the	  follow	  up	  to	  more	  than	  a	  year	  cumulative	  incidence	  of	  PLT	  recovery	  was	  72%	  (CI95%	  54-­‐96)	  for	  patients	  undergone	  IBCBT	  versus	  50%	  (CI	  95%32-­‐77)	  for	  patients	  undergone	  intravenous	  CBHSCT	  (P¼	  0,03).	  About	  PLT	  engraftment	  we	  found	  no	  statistically	  significant	  differences	  according	  to	  Total	  Nucleated	  Cells	  infused,	  CD34þ	  cells	  infused	  and	  HLA	  mismatches	  in	  donor-­‐recipient	  couple	  and	  when	  we	  considered	  the	  association	  between	  TNC	  and	  CD34þ	  cells	  separately	  in	  the	  IBCBT	  group	  (n¼	  18)	  and	  in	  the	  intravenous	  CBHSCT	  group	  (n¼	  19)	  we	  observed	  a	  trend	  toward	  a	  stronger	  impact	  of	  cell	  dose	  in	  the	  intravenous	  CBHSCT	  group.	  	  Conclusion	  IBCBT	  has	  been	  shown	  to	  be	  one	  of	  the	  most	  reliable	  solutions	  to	  overcome	  some	  of	  the	  limitations	  of	  CBHSCT,	  but	  data	  justifying	  the	  risks	  related	  to	  this	  procedure	  are	  still	  missing.	  Our	  data	  suggest	  that	  by	  intra-­‐bone	  injection	  it	  is	  possible	  to	  overcome	  the	  problem	  of	  delayed	  platelet	  engraftment	  in	  CBHSCT	  even	  if	  further	  data	  are	  needed	  to	  confirm	  the	  results	  obtained.	  	  Disclosure	  of	  Interest	  None	  declared.	  	  	  

Intra-bone cord blood injection is associated with improved platelet
engraftment compared to intravenous cord blood hematopoietic stem cell
transplantation both in adult and pediatric patients

https://iris.unito.it/retrieve/handle/2318/1609072/254893/Saglio%20et%20al%20EBMT%20Abstract%20preprint%202015.pdf

Intra-bone cord blood injection is associated with improved platelet

engraftment compared to intravenous cord blood hematopoietic stem cell

transplantation both in adult and pediatric patients

Intra-bone cord blood injection is associated with improved platelet engraftment compared to intravenous cord blood hematopoietic stem cell transplantation both in adult and pediatric patients

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