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Umbilical cord blood expansion with nicotinamide provides long-term multilineage engraftment.

2014 Jul

Journal Article

Horwitz, M.E.; Chao, N.J.; Rizzieri, D.A.; Long, G.D.; Sullivan, K.M.; Gasparetto, C.; Chute, J.P.; Morris, A.; McDonald, C.; Waters-Pick, B.; Stiff, P.; Wease, S.; Peled, A.; Snyder, D.; Cohen, E.Galamidi; Shoham, H.; Landau, E.; Friend, E.; Peleg, I.; Aschengrau, D.; Yackoubov, D.; Kurtzberg, J.; Peled, T.

J Clin Invest






Adult; Cord Blood Stem Cell Transplantation; Fetal Blood; Graft Survival; Hematologic Neoplasms; Hematopoiesis; Humans; Middle Aged; Niacinamide; Transplantation Chimera; Transplantation Conditioning; Treatment Outcome; Young Adult

BACKGROUND: Delayed hematopoietic recovery is a major drawback of umbilical cord blood (UCB) transplantation. Transplantation of ex vivo-expanded UCB shortens time to hematopoietic recovery, but long-term, robust engraftment by the expanded unit has yet to be demonstrated. We tested the hypothesis that a UCB-derived cell product consisting of stem cells expanded for 21 days in the presence of nicotinamide and a noncultured T cell fraction (NiCord) can accelerate hematopoietic recovery and provide long-term engraftment.METHODS: In a phase I trial, 11 adults with hematologic malignancies received myeloablative bone marrow conditioning followed by transplantation with NiCord and a second unmanipulated UCB unit. Safety, hematopoietic recovery, and donor engraftment were assessed and compared with historical controls.RESULTS: No adverse events were attributable to the infusion of NiCord. Complete or partial neutrophil and T cell engraftment derived from NiCord was observed in 8 patients, and NiCord engraftment remained stable in all patients, with a median follow-up of 21 months. Two patients achieved long-term engraftment with the unmanipulated unit. Patients transplanted with NiCord achieved earlier median neutrophil recovery (13 vs. 25 days, P < 0.001) compared with that seen in historical controls. The 1-year overall and progression-free survival rates were 82% and 73%, respectively.CONCLUSION: UCB-derived hematopoietic stem and progenitor cells expanded in the presence of nicotinamide and transplanted with a T cell-containing fraction contain both short-term and long-term repopulating cells. The results justify further study of NiCord transplantation as a single UCB graft. If long-term safety is confirmed, NiCord has the potential to broaden accessibility and reduce the toxicity of UCB transplantation.TRIAL REGISTRATION: NCT01221857.FUNDING: Gamida Cell Ltd.

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