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1 c- C! w; t* x7 ?Published in final edited form as:
3 W8 N1 n2 ]+ s# P2 H( Z2 DBiol Blood Marrow Transplant. 2009 December ; 15(12): 1596–1602. doi:10.1016/j.bbmt.2009.08.009.
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A “No-wash” Albumin-Dextran Dilution Strategy for Cord Blood
' D2 t9 V- m( |9 L. b# qUnit Thaw: High Rate of Engraftment and a Low Incidence of
# _ i# s) |0 G- g% H% F, gSerious Infusion Reactions
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Abstract
# m9 t: Z: j. }, yPreparation of cord blood (CB) units for infusion by albumin-dextran dilution without3 V$ j) X8 m3 G2 m5 n. [1 X2 ^" R
centrifugation may be advantageous for adult patients to minimize cell loss and, unlike a bedside+ T0 \) w4 @ W, T0 C' G2 q6 g* Z
thaw, is still conducted in the controlled laboratory environment. Therefore, we studied CB
) `) {/ F4 C( M- c6 Htransplantation (CBT) using this technique in 54 consecutive CBT recipients ≥20 kg. Patients. k# x" ]0 J C. S, K z
[median age 42 years (range 7–66); median weight 71 kg (range 24–109)] were transplanted for
% G( L' H1 ^8 j/ j, M- thigh-risk hematological malignancies with ablative (n=35) or non-ablative (n=19) conditioning. j3 d2 t% p) U$ r
and 4–6/6 human leukocyte antigen (HLA)-matched double unit grafts. One hundred and seven' ?, j. T4 P, R- J: Z. | S8 @
units were thawed with dilution whereas 1 red blood cell (RBC) replete unit was washed. A 5:1% ?( |) A; X4 \2 O* |' X
dextran 40/ 25% albumin solution was used. RBC depleted units (n=104) were diluted ≥5.5 fold- @, ^* z) f* J/ m1 c# P$ \
[median final volume 200 ml (range 200–500)] whereas RBC replete units (n=3) were diluted ≥4
, T4 d0 G& B; r. X* \% z" kfold [median final volume 400 ml (range 400–535)]. Total nucleated cell (TNC) recovery was$ }! S5 X7 f) z" q1 _4 }* C# ?4 t
86%; the median infused TNC dose was 2.17 × 107/kg/unit. While 35 patients (65%) had a total of! D" p7 K+ L* E9 `$ J& F& [
45 infusion reactions (6 nausea, 31 hypertension, 3 pain, 1 rigors/fever, 2 transient hypoxia, 2/ v+ m0 w7 w/ T7 o0 u9 u$ h
renal impairment) requiring additional therapy, there were no infusion-related serious adverse
3 m/ V4 m3 ~7 H' w8 ?events, and reactions were not related to DMSO dose/kg. Cumulative incidence of sustained donor
* A8 Z" Z3 N' k/ v0 g( P2 O7 Cengraftment was 94% (95%CI: 87–100) with neutrophil recovery occurring at a median of 25 days
+ J- _9 D) D2 a: k(range 13–43) in ablative and 10 days (range 7–36) in non-myeloablative recipients. CB thaw with
6 I. a2 s4 u% B; s, v: Kalbumin-dextran dilution reduces unit manipulation, and minimizes cell loss, speeds time to S& V8 S- N! @ }+ o0 {
infusion, is associated with a tolerable infusion reaction profile, and a high rate of sustained/ f, A# e( K; X7 L6 F$ R6 y
engraftment in CBT recipients ≥20 kg.
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