Cord Blood Establishing a National Hematopoietic Stem Cell Bank Program (2005) / Chapter Skim
Currently Skimming:
Appendix G: Analysis of the NYBC, NMDP, and NHLBI Cord Blood Data
Appendix G: Analysis of the NYBC, NMDP, and NHLBI Cord Blood Data
Pages 273-282
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 273... ...
, and the National Heart, Lung, and Blood Institute (NHLBI) Cord Blood Banking and Transplantation (COBLT)
|
From page 274... ...
, disease type (leukemia versus genetic or other) , risk (0 to 3 on the International Bone Marrow Transplant Registry [IBMTR]
|
From page 275... ...
. Table G-1 reveals that of the three blood banks, NHLBI had the highest survival rates (p < .021)
|
From page 276... ...
, and both 4/6 and 5/6 HLA matches increased the engraftment failure rate relative to that achieved with a 6/6 match (p < .002 and p < .007 respectively)
|
From page 277... ...
Although this finding is biologically questionable, the highest cell dose for a 6/6 match yielded a lower survival rate than the low and medium cell doses. This effect may simply be due to the small number of 6/ 6 HLA matches in the combined database (n = 34, see Table G-3)
|
From page 278... ...
In terms of treatment failure, patients with 6/6 matches exhibited dramatically decreased rates of engraftment failure relative to those for patients with 4/6 and 5/6 HLA matches for all cell doses; however, the HLA effect decreased with increasing cell dose. To further illustrate the magnitudes of these effects, the cumulative survival distributions for each HLA group and TNC/kg group are displayed in Figures G-1 to G-3.
|
From page 279... ...
These findings support the use of the ratio TNC/kg for the modeling of cord blood transplant outcomes. DISCUSSION The results of this analysis reveal that if we take the competing risks of mortality and engraftment failure into consideration and adjust for disease type, risk, age, weight, CMV infection, sex, race, and time, the cumulative survival benefits for 4/6 and 5/6 HLA matches are grossly inferior to a perfect 6/6 HLA match for small cell doses (<2.5 × 107 TNC/kg)
|
From page 280... ...
Table G-4 presents a breakdown of cell dose by HLA matches. Table G-4 reveals that 20 percent of all transplants were conducted with low cell doses in patients with 4/6 and 5/6 HLA matches.
|
From page 281... ...
First, despite the pooling of data from all three major cord blood banks, the sample size is still small, given the large number of effects estimated from these data and the separate set of coefficients for the two competing risks. Second, there are only a small proportion of patients with a perfect 6/6 HLA match.
|
From page 282... ...
282 CORD BLOOD cell dose are confounded in that only young children are capable of receiving high cell doses. For example, Table G-4 reveals that only 2 percent of the high cell doses were transplanted into patients over 16 years of age.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.