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" } y' b( _/ E! z. t' xPublished in final edited form as:
8 q0 O0 u+ w$ E- v% R7 V2 mBiol Blood Marrow Transplant. 2009 December ; 15(12): 1596–1602. doi:10.1016/j.bbmt.2009.08.009.
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" a) w( `' D% o7 u# s3 l8 I: oA “No-wash” Albumin-Dextran Dilution Strategy for Cord Blood: U9 e9 L) \( @; z# N5 I p
Unit Thaw: High Rate of Engraftment and a Low Incidence of
' w' I" U3 g9 S( F- K( P: ZSerious Infusion Reactions
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Abstract
; x- x+ K0 }! F$ gPreparation of cord blood (CB) units for infusion by albumin-dextran dilution without9 p1 |! T( H+ g' r/ W( l$ P
centrifugation may be advantageous for adult patients to minimize cell loss and, unlike a bedside
3 m! c# J) \/ o& T4 Dthaw, is still conducted in the controlled laboratory environment. Therefore, we studied CB& l" H- R% k/ R5 _) A. S4 O! c
transplantation (CBT) using this technique in 54 consecutive CBT recipients ≥20 kg. Patients: m6 [/ f4 P3 t+ p
[median age 42 years (range 7–66); median weight 71 kg (range 24–109)] were transplanted for0 ?& O1 P0 F' r3 V: h, I; W8 Z
high-risk hematological malignancies with ablative (n=35) or non-ablative (n=19) conditioning
+ x' H# e8 c4 [$ l2 w2 U0 Q) S/ Xand 4–6/6 human leukocyte antigen (HLA)-matched double unit grafts. One hundred and seven
8 m s0 \% O0 D' Z% A9 K* eunits were thawed with dilution whereas 1 red blood cell (RBC) replete unit was washed. A 5:1. ?* b6 s5 j0 g
dextran 40/ 25% albumin solution was used. RBC depleted units (n=104) were diluted ≥5.5 fold3 n7 \. L# Z$ P4 z% Z
[median final volume 200 ml (range 200–500)] whereas RBC replete units (n=3) were diluted ≥4) s, c+ {# ?' z
fold [median final volume 400 ml (range 400–535)]. Total nucleated cell (TNC) recovery was: @! J5 r8 a3 r$ B( U4 U
86%; the median infused TNC dose was 2.17 × 107/kg/unit. While 35 patients (65%) had a total of
5 A1 H2 L5 |9 I* n" s45 infusion reactions (6 nausea, 31 hypertension, 3 pain, 1 rigors/fever, 2 transient hypoxia, 2
% H' Z' t. }4 u* frenal impairment) requiring additional therapy, there were no infusion-related serious adverse
, r, U" M( k; |9 Aevents, and reactions were not related to DMSO dose/kg. Cumulative incidence of sustained donor
( o9 c5 i. B9 w/ r9 X- m2 `engraftment was 94% (95%CI: 87–100) with neutrophil recovery occurring at a median of 25 days z' i' L% @. b; t
(range 13–43) in ablative and 10 days (range 7–36) in non-myeloablative recipients. CB thaw with4 C E. i* ?8 q0 P2 `+ @# k9 N
albumin-dextran dilution reduces unit manipulation, and minimizes cell loss, speeds time to% `! |! P3 ?. u% S4 ^
infusion, is associated with a tolerable infusion reaction profile, and a high rate of sustained
$ C: d# Y. C% v( ^! fengraftment in CBT recipients ≥20 kg.
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发表于 2014-5-6 12:15
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