A "No-wash" Albumin-Dextran Dilution Strategy for Cord Blood Unit Thaw

High Rate of Engraftment and a Low Incidence of Serious Infusion Reactions

Juliet N. Barker, Michelle Abboud, Robert D. Rice, Rebecca Hawke, Allison Schaible, Glenn Heller, Vincent La Russa, Andromachi Scaradavou

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Preparation of cord blood (CB) units for infusion by albumin-dextran dilution without centrifugation may be advantageous for adult patients to minimize cell loss and, unlike a bedside thaw, is still conducted in the controlled laboratory environment. Therefore, we studied CB transplantation (CBT) using this technique in 54 consecutive CBT recipients >20 kg. Patients (median age=42 years [range: 7-66 years]; median weight=71 kg [range: 24-109]) were transplanted for high-risk hematologic malignancies with myeloablative (n=35) or nonmyeloablative (n=19) conditioning and 4-6/6 human leukocyte antigen (HLA)-matched double-unit grafts. One hundred seven units were thawed with dilution, whereas 1 red blood cell (RBC)-replete unit was washed. A 5:1 dextran 40%/25% albumin solution was used. RBC-depleted units (n=104) were diluted ≥5.5-fold (median final volume 200 mL [range: 200-500]), whereas RBC-replete units (n=3) were diluted ≥4-fold (median final volume 400 mL [range: 400-535]). Total nucleated cell (TNC) recovery was 86%; the median infused TNC dose was 2.17×107/kg/unit. Although 35 patients (65%) had a total of 45 infusion reactions (6 nausea, 31 hypertension, 3 pain, 1 rigors/fever, 2 transient hypoxia, 2 renal impairment) requiring additional therapy, there were no infusion-related serious adverse events, and reactions were not related to dimethyl sulfoxide (DMSO) dose/kg. Cumulative incidence of sustained donor engraftment was 94% (95% cumulative incidence [CI]: 87-100) with neutrophil recovery occurring at a median of 25 days (range: 13-43) in myeloablative and 10 days (range: 7-36) in nonmyeloablative recipients. CB thaw with albumin-dextran dilution reduces unit manipulation, and minimizes cell loss, speeds time to infusion, is associated with a tolerable infusion reaction profile, and a high rate of sustained engraftment in CBT recipients ≥20 kg.

Original languageEnglish
Pages (from-to)1596-1602
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume15
Issue number12
DOIs
StatePublished - Dec 1 2009

Fingerprint

Dextrans
Fetal Blood
Albumins
Transplantation
Erythrocytes
Incidence
Controlled Environment
Hematologic Neoplasms
HLA Antigens
Dimethyl Sulfoxide
Centrifugation
Neutrophils
Fever
Tissue Donors
Hypertension
Transplants
Kidney
Weights and Measures
Pain
Therapeutics

Keywords

  • Cord Blood
  • Cryopreservation
  • Hematopoeitic stem cell transplantation

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

A "No-wash" Albumin-Dextran Dilution Strategy for Cord Blood Unit Thaw : High Rate of Engraftment and a Low Incidence of Serious Infusion Reactions. / Barker, Juliet N.; Abboud, Michelle; Rice, Robert D.; Hawke, Rebecca; Schaible, Allison; Heller, Glenn; La Russa, Vincent; Scaradavou, Andromachi.

In: Biology of Blood and Marrow Transplantation, Vol. 15, No. 12, 01.12.2009, p. 1596-1602.

Research output: Contribution to journalArticle

Barker, Juliet N. ; Abboud, Michelle ; Rice, Robert D. ; Hawke, Rebecca ; Schaible, Allison ; Heller, Glenn ; La Russa, Vincent ; Scaradavou, Andromachi. / A "No-wash" Albumin-Dextran Dilution Strategy for Cord Blood Unit Thaw : High Rate of Engraftment and a Low Incidence of Serious Infusion Reactions. In: Biology of Blood and Marrow Transplantation. 2009 ; Vol. 15, No. 12. pp. 1596-1602.
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abstract = "Preparation of cord blood (CB) units for infusion by albumin-dextran dilution without centrifugation may be advantageous for adult patients to minimize cell loss and, unlike a bedside thaw, is still conducted in the controlled laboratory environment. Therefore, we studied CB transplantation (CBT) using this technique in 54 consecutive CBT recipients >20 kg. Patients (median age=42 years [range: 7-66 years]; median weight=71 kg [range: 24-109]) were transplanted for high-risk hematologic malignancies with myeloablative (n=35) or nonmyeloablative (n=19) conditioning and 4-6/6 human leukocyte antigen (HLA)-matched double-unit grafts. One hundred seven units were thawed with dilution, whereas 1 red blood cell (RBC)-replete unit was washed. A 5:1 dextran 40{\%}/25{\%} albumin solution was used. RBC-depleted units (n=104) were diluted ≥5.5-fold (median final volume 200 mL [range: 200-500]), whereas RBC-replete units (n=3) were diluted ≥4-fold (median final volume 400 mL [range: 400-535]). Total nucleated cell (TNC) recovery was 86{\%}; the median infused TNC dose was 2.17×107/kg/unit. Although 35 patients (65{\%}) had a total of 45 infusion reactions (6 nausea, 31 hypertension, 3 pain, 1 rigors/fever, 2 transient hypoxia, 2 renal impairment) requiring additional therapy, there were no infusion-related serious adverse events, and reactions were not related to dimethyl sulfoxide (DMSO) dose/kg. Cumulative incidence of sustained donor engraftment was 94{\%} (95{\%} cumulative incidence [CI]: 87-100) with neutrophil recovery occurring at a median of 25 days (range: 13-43) in myeloablative and 10 days (range: 7-36) in nonmyeloablative recipients. CB thaw with albumin-dextran dilution reduces unit manipulation, and minimizes cell loss, speeds time to infusion, is associated with a tolerable infusion reaction profile, and a high rate of sustained engraftment in CBT recipients ≥20 kg.",
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