A 'no-wash' albumin-dextran dilution strategy for cord blood unit thaw: high rate of engraftment and a low incidence of serious infusion reactions
| Autor: | R.D. Rice, Rebecca Hawke, Andromachi Scaradavou, Juliet N. Barker, Vincent La Russa, Michelle Abboud, Glenn Heller, Allison Schaible |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Cord Blood Cryopreservation Article Hematopoeitic stem cell transplantation chemistry.chemical_compound Young Adult Albumins Medicine Humans Cumulative incidence Dimethyl Sulfoxide Prospective Studies Adverse effect Child Aged Transplantation business.industry Dimethyl sulfoxide Albumin Dextrans Hematology Middle Aged Fetal Blood Surgery Red blood cell medicine.anatomical_structure chemistry Blood Preservation Anesthesia Cord blood Female Cord Blood Stem Cell Transplantation business |
| Zdroj: | Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 15(12) |
| ISSN: | 1523-6536 |
| Popis: | Preparation of cord blood (CB) units for infusion by albumin-dextran dilution without centrifugation may be advantageous for adult patients to minimize cell loss and, unlike a bedside thaw, is still conducted in the controlled laboratory environment. Therefore, we studied CB transplantation (CBT) using this technique in 54 consecutive CBT recipients20 kg. Patients (median age=42 years [range: 7-66 years]; median weight=71 kg [range: 24-109]) were transplanted for high-risk hematologic malignancies with myeloablative (n=35) or nonmyeloablative (n=19) conditioning and 4-6/6 human leukocyte antigen (HLA)-matched double-unit grafts. One hundred seven units were thawed with dilution, whereas 1 red blood cell (RBC)-replete unit was washed. A 5:1 dextran 40%/25% albumin solution was used. RBC-depleted units (n=104) were dilutedor=5.5-fold (median final volume 200 mL [range: 200-500]), whereas RBC-replete units (n=3) were dilutedor=4-fold (median final volume 400 mL [range: 400-535]). Total nucleated cell (TNC) recovery was 86%; the median infused TNC dose was 2.17x10(7)/kg/unit. Although 35 patients (65%) had a total of 45 infusion reactions (6 nausea, 31 hypertension, 3 pain, 1 rigors/fever, 2 transient hypoxia, 2 renal impairment) requiring additional therapy, there were no infusion-related serious adverse events, and reactions were not related to dimethyl sulfoxide (DMSO) dose/kg. Cumulative incidence of sustained donor engraftment was 94% (95% cumulative incidence [CI]: 87-100) with neutrophil recovery occurring at a median of 25 days (range: 13-43) in myeloablative and 10 days (range: 7-36) in nonmyeloablative recipients. CB thaw with albumin-dextran dilution reduces unit manipulation, and minimizes cell loss, speeds time to infusion, is associated with a tolerable infusion reaction profile, and a high rate of sustained engraftment in CBT recipientsor=20 kg. |
| Databáze: | OpenAIRE |
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