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. p! [( M! W: n- bPublished in final edited form as:5 m2 r0 Y. K( c' }+ \* J
Biol 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 Blood5 G& W u4 _$ Q' e) n
Unit Thaw: High Rate of Engraftment and a Low Incidence of5 _6 X2 B8 N: u8 O# m
Serious Infusion Reactions4 Z( I) k+ ]2 c$ W3 d; v- ?
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Abstract/ P3 b4 w9 A2 U/ P
Preparation of cord blood (CB) units for infusion by albumin-dextran dilution without% r& H# d2 c& W0 c$ i6 g" F
centrifugation may be advantageous for adult patients to minimize cell loss and, unlike a bedside2 a1 p$ V7 K( m5 v) R
thaw, is still conducted in the controlled laboratory environment. Therefore, we studied CB! `2 X2 v. T( J: M6 M5 H
transplantation (CBT) using this technique in 54 consecutive CBT recipients ≥20 kg. Patients
; ^# W& S& q6 L& P) v( Q( r( U[median age 42 years (range 7–66); median weight 71 kg (range 24–109)] were transplanted for
5 K: w- h% \, O' V' bhigh-risk hematological malignancies with ablative (n=35) or non-ablative (n=19) conditioning2 |5 T$ t. B" v2 M! {5 R
and 4–6/6 human leukocyte antigen (HLA)-matched double unit grafts. One hundred and seven% o' |7 Q; |# s' N! A+ V/ Q+ l
units were thawed with dilution whereas 1 red blood cell (RBC) replete unit was washed. A 5:1
! O0 Q H- p6 M: f% A. pdextran 40/ 25% albumin solution was used. RBC depleted units (n=104) were diluted ≥5.5 fold
0 }6 O( [9 v1 b$ n# S8 _[median final volume 200 ml (range 200–500)] whereas RBC replete units (n=3) were diluted ≥44 M: x! m5 S4 {5 Z
fold [median final volume 400 ml (range 400–535)]. Total nucleated cell (TNC) recovery was$ n$ K4 D# }+ A! j5 ?
86%; the median infused TNC dose was 2.17 × 107/kg/unit. While 35 patients (65%) had a total of
. U/ n8 X) R/ P45 infusion reactions (6 nausea, 31 hypertension, 3 pain, 1 rigors/fever, 2 transient hypoxia, 2$ k+ |6 `1 K. F
renal impairment) requiring additional therapy, there were no infusion-related serious adverse
8 f' m" [ a; w- bevents, and reactions were not related to DMSO dose/kg. Cumulative incidence of sustained donor
9 m2 i3 e4 H) }# a' z2 {7 Z; `engraftment was 94% (95%CI: 87–100) with neutrophil recovery occurring at a median of 25 days$ i" p# i( y2 z/ q3 F* Z% a
(range 13–43) in ablative and 10 days (range 7–36) in non-myeloablative recipients. CB thaw with
# V: |1 Z( b& D# |! }albumin-dextran dilution reduces unit manipulation, and minimizes cell loss, speeds time to- m& J' a+ a$ U7 F
infusion, is associated with a tolerable infusion reaction profile, and a high rate of sustained
8 M5 I7 z0 _: O) e% e# \engraftment in CBT recipients ≥20 kg.
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