{"doi":"10.1182/bloodadvances.2020003371","title":"High progression-free survival after intermediate intensity double unit cord blood transplantation in adults","abstract":"Cord blood transplantation (CBT) after high intensity or nonmyeloablative conditioning has limitations. We investigated cyclosporine-A/mycophenolate mofetil-based intermediate intensity (cyclophosphamide 50 mg/kg, fludarabine 150 mg/m2, thiotepa 10 mg/kg, total body irradiation 400 cGy) unmanipulated double-unit CBT (dCBT) with prioritization of unit quality and CD34+ cell dose in graft selection. Ninety adults (median age, 47 years [range, 21-63]; median hematopoietic cell transplantation comorbidity index, 2 [range, 0-8]; 61 [68%] acute leukemia) received double-unit grafts (median CD34+ cell dose, 1.3 × 105/kg per unit [range, 0.2-8.3]; median donor-recipient human leukocyte antigen (HLA) match, 5/8 [range 3-7/8]). The cumulative incidences of sustained CB engraftment, day 180 grade III-IV acute, and 3-year chronic graft-versus-host disease were 99%, 24%, and 7%, respectively. Three-year transplant-related mortality (TRM) and relapse incidences were 15% and 9%, respectively. Three-year overall survival (OS) is 82%, and progression-free survival (PFS) is 76%. Younger age and higher engrafting unit CD34+ cell dose both improved TRM and OS, although neither impacted PFS. Engrafting unit-recipient HLA match was not associated with any outcome with a 3-year PFS of 79% in 39 patients engrafting with 3-4/8 HLA-matched units. In 52 remission acute leukemia patients, there was no association between minimal residual disease (MRD) and 3-year PFS: MRD negative of 88% vs MRD positive of 77% (P = .375). Intermediate intensity dCBT is associated with high PFS. Use of highly HLA mismatched and unmanipulated grafts permits wide application of this therapy, and the low relapse rates support robust graft-versus-leukemia effects even in patients with MRD.","journal":"Blood Advances","year":2020,"id":66518,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":51,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9534,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":90690,"name":"Sean M. 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Dahi","orcid":"0000-0002-0794-3226","position":10,"is_corresponding":false},{"id":108874,"name":"Sergio Giralt","orcid":"0000-0003-1944-5053","position":11,"is_corresponding":false},{"id":108871,"name":"Boglarka Gyurkocza","orcid":"0000-0002-2933-2119","position":12,"is_corresponding":false},{"id":352730,"name":"Alan M. Hanash","orcid":"0000-0002-3273-3634","position":13,"is_corresponding":false},{"id":320883,"name":"Katharine C. Hsu","orcid":"0000-0003-2827-5324","position":14,"is_corresponding":false},{"id":352731,"name":"Ann A. Jakubowski","orcid":"0000-0003-1955-513X","position":15,"is_corresponding":false},{"id":268592,"name":"Esperanza B. Papadopoulos","orcid":"0000-0001-6066-1861","position":16,"is_corresponding":false},{"id":225648,"name":"Jonathan U. Peled","orcid":"0000-0002-4029-7625","position":17,"is_corresponding":false},{"id":108873,"name":"Miguel‐Angel Perales","orcid":"0000-0002-5910-4571","position":18,"is_corresponding":false},{"id":237601,"name":"Craig S. 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