Low Rate of Infusional Toxicity following Expanded Cord Blood Transplantation

Umbilical cord blood (CB) is utilized with increasing frequency to restore hematopoiesis in bone marrow transplant patients lacking a suitable HLA-matched donor. CB transplantation is limited by low cell doses and delays in neutrophil and platelet engraftment. CB progenitors expanded ex vivo prior to transplantation provide more rapid hematopoietic and immune reconstitution, as well as less engraftment failure compared to unmanipulated CB. However, the safety of infusing double and ex vivo expanded CB has not been systematically examined. Here we review the immediate adverse events (AE) associated with the infusion of CB occurring within 24 hours in 137 patients enrolled in clinical CB transplant trials at the MD Anderson Cancer Center from February 2004 to May 2010. All patients received an unmanipulated CB unit followed by infusion of a second unmanipulated CB unit or a second CB unit expanded ex vivo using cytokines in a liquid culture system or in mesenchymal stromal cell co-cultures. A total of three Grade 2 and two Grade 3 infusion reactions occurred within 24 hours of CB transplantation. This resulted in an AE rate of 3.7%. The majority of AEs manifested as signs of hypertension. No association with © 2013 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved. Corresponding authors: Catherine M Bollard, MD, Center for Cell and Gene Therapy, Baylor College of Medicine, 1102 Bates Street, Houston, Texas 77030, Phone: 832-824-4734, Fax: 832-825-4732, cmbollar@txch.org, Elizabeth J Shpall, MD, Department of Stem Cell Transplantation, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas 77030, Phone: 713-745-2161, Fax: 713-794-4902, eshpall@mdanderson.org. †These authors have contributed equally to this work Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. FINANCIAL DISCLOSURE All authors declare no financial conflicts of interest associated with the publication of this manuscript. NIH Public Access Author Manuscript Cytotherapy. Author manuscript; available in PMC 2015 August 01. Published in final edited form as: Cytotherapy. 2014 August ; 16(8): 1153–1157. doi:10.1016/j.jcyt.2013.12.011. N IH -P A A uhor M anscript N IH -P A A uhor M anscript N IH -P A A uhor M anscript patient age, sex, disease status, premedication, ABO compatibility or total infusion volume was observed. In summary, the incidence of infusion related toxicities in patients who receive unmanipulated and ex vivo-expanded double CB transplantation is low. We conclude that the infusion of unmanipulated followed by expanded CB products is a safe procedure associated with a low probability of inducing severe reactions.