The impact of antenatal and perinatal variables on cord blood haemopoietic stem/progenitor cell yield available for transplantation.

We investigated the impact of maternal and fetal variables on cord blood (CB) haemopoietic stem/progenitor cell content. These included maternal age, ethnic origin, parity, ABO and Rhesus D blood group, antenatal haemoglobin, alcohol and cigarette consumption at time of registration, mode of delivery, duration of the first and second stages of labour, gestational age, birth weight, cord pH and cord erythrocyte mean cell volume (MCV). Cord volumes and total nucleated cellularities (TNC) were recorded, the colony assay for granulocyte-macrophage colony-forming-cells (CFU-GM) was used to quantify the progenitor cells and the potential of CFU-GM to produce secondary colonies on replating was used as a measure of progenitor cell quality. We found: (1) significantly greater (P=0.04) volumes were collected from babies who weighed > or = 2.5kg versus babies with a birth weight <2.5kg; (2) significantly greater numbers of mononuclear cells (MNC) from mothers who drank 0-3 units versus those who drank > or = 4 units of alcohol weekly (P=0.03), and in babies with a cord pH < or = 7.1 v > 7.1 (P=0.02); (3) Significantly greater numbers of cord CFU-GM in mothers who drank 0-3 v > or = 4 units weekly (P=0.004) and smokers of > or = 10 v 0-9 cigarettes daily (P=0.02) and in spontaneous vaginal deliveries than assisted vaginal and caesarean deliveries (P=0.04), and (4) the potential of CFU-GM to produce secondary colonies was significantly greater in CB derived from Caucasians than from non-Caucasians ( P=0.02); in assisted vaginal delivery v spontaneous vaginal (P=0.02) and in deliveries with prolonged first stage of labour v short first stage of labour (P=0.04). We conclude that antenatal and perinatal variables may influence the CB stem/progenitor cell yield available for transplantation.

Allogeneic bone marrow transplantation for chronic myeloid leukemia using sibling and volunteer unrelated donors. A comparison of complications in the first 2 years.

OBJECTIVE: To compare the short- and medium-term complications (particularly infection) of bone marrow transplantation for chronic myeloid leukemia in patients with HLA-identical sibling donors or volunteer unrelated donors. DESIGN: Retrospective review of two cohorts of patients. SETTING: Tertiary referral center. PATIENTS: One hundred three patients with chronic myeloid leukemia in first chronic phase. INTERVENTION: Patients were treated with bone marrow transplantation using marrow from HLA-identical siblings (n = 57) and volunteer donors (n = 46). MAIN RESULTS: In total, 68 patients survived a median of 22 months from bone marrow transplant (range, 7 to 81 months). The actuarial probabilities of overall survival and leukemia-free survival at 2 years for the sibling donor group were 73% (95% CI, 60% to 86%) and 72% (CI, 60% to 84%), respectively, and for the volunteer donor group, 47% (CI, 31% to 63%) and 42% (CI, 26% to 58%) (P = 0.07 and 0.05, respectively). However, after adjustment for duration of disease, overall and disease-free survival in the two donor groups did not differ significantly. A major problem was an increased incidence of severe viral infection in the volunteer unrelated donor group (19 episodes in 16 of 46 patients compared with 7 episodes in 7 of 57 sibling donor patients, P = 0.01). The actuarial incidence of chronic graft-versus-host disease (GVHD) was higher in volunteer unrelated donor patients (77% [CI, 63% to 91%] compared with 49% [CI, 35% to 63%]; P = 0.02) but that of acute GVHD was not. The median performance status of the survivors in the volunteer donor group is similar to that in the sibling donor group. The incidence of hematologic relapse in both groups so far is low. CONCLUSION: Results appear to justify the continued use of volunteer donors in chronic-phase chronic myeloid leukemia, but infection and chronic GVHD are still major problems.