�Intrabone giving medication of unrelated umbilical-cord-blood cells overcomes the problem of graft failure seen with intravenous governance and is associated with a depressed incidence of graft-versus-host disease*, making the technique potentially useful in a large number of adult patients with acute leukaemia, according to findings from a phase I/II study, promulgated early
Online and in the September edition of The Lancet Oncology.
Cord-blood transplantation is an effective treatment for haematological malignancies, but alone a small number of adult patients can undergo this operation due to the high proportion of graft failures that occur (as a result of the low number of nucleated cells contained in a cord blood unit) and the high incidence of graft-versus-host disease that follows. Dr Francesco Frassoni (San Martino Hospital, Genoa, Italy) and colleagues investigated intrabone injection of cord-blood cells as an alternative to intravenous injection, to tax whether this new approach was able-bodied to guarantee engraftment and shorten the time to complete hemopoietic recovery.
Between March 31, 2006, and Jan 25, 2008, the safety and efficacy of intrabone injection was assessed in 32 patients with acute myeloid leukaemia or acute lymphoblastic leukaemia. A suitable unrelated cord-blood unit was establish for each patient, and human white corpuscle antigen (HLA) matching was 5/6 for nine patients, 4/6 for 22 patients, and 3/6 for unmatchable patient. The cord-blood cells were concentrated in 5-mL syringes and were injected into the superior-posterior iliac crest under rapid general anaesthesia. The primary termination was the probability of neutrophil and platelet recovery, and secondary endpoints were incidence of graft-versus-host disease, relapse, and overall endurance.
Of 28 assessable patients, all achieved complete neutrophile recovery (median time to recovery 23 days [range 14-44]) and 27 patients achieved nail platelet recovery (median time to recovery 36 days [range 16-64]). All 27 patients showed complete reconstitution of hemogenesis from cord blood cells, and no patient role had secondary graft failure. Importantly, no patients developed grade III-IV acute graft-versus-host disease. Overall survival was 45% at 1 class, with a median follow-up of 13 months (compass 3-23).
Dr Frassoni concludes: "This technique might be possible in a large number of adult patients. The reduced incidence of acute graft-versus-host disease is intriguing. If these findings are proved in a larger series of patients, direct intrabone injection will have the potential to affect the current practice of hematopoietic stem-cell organ transplant".
*Graft-versus-host disease is a common complication after an allogeneic transpose, in which immune cells from the donor onrush the body of the recipient, and can range from modest to severe. When the immune cells do not recognise HLA expressed on the recipient's cells they attack those cells, devising HLA matching important for such transplants.
"Direct intrabone transplant of unrelated cord blood cells in acute leukaemia: a stage I/II study"Francesco Frassoni, Francesca Gualandi, Marina Podest� Anna Maria Raiola, Adalberto Ibatici, Giovanna Piaggio, Mario Sessarego, Nadia Sessarego, Marco Gobbi, Nicoletta Sacchi, Myriam Labopin, Andrea Bacigalupo
The Lancet Oncology, Aug 9th 2008 - DOI:10.1016/S1470-2045(08)70180-3
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www.thelancet.com/journals/lanonc
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