Intrabone route may delay engraftment failure

GENOA-Investigators from the San Martino Hospital in Italy are reporting that direct intrabone cord-blood transplantation overcomes graft failure even when low numbers of human leucocyte antigen-mismatched cord-blood cells are transplanted. This new technique may prevent the delayed or failed engraftment associated with about 20% of adult patients.

In their phase I/phase II study, Francesco Frassoni, MD, and colleagues set out to establish the safety and efficacy of an intrabone route for cord-blood cells, measured by the donor-derived neutrophil and platelet engraftment (Lancet Oncology, August 8, 2008).

Thirty-two consecutive patients with acute myeloid leukemia (n = 20) or acute lymphoblastic leukemia (n = 12) underwent a cord-blood transplant.

The primary endpoint of the study was the probability of neutrophil and platelet recovery after intrabone cord-blood transplantation.

Median time to recovery of neutrophils in 28 patients (≥ 0.5×109/L) was 23 days and median time to recovery of platelets in 27 patients (≥ 20×109/L) was 36 days.

All patients were fully chimeric from 30 days after transplantation to the last follow-up visit, suggesting an early complete donor engraftment.