Posttransplantation engraftment and safety of cord blood transplantation with grafts containing relatively low cell doses in adults

The cell dose of a graft is a critical determinant of hematopoietic recovery and survival following unrelated cord blood transplantation. Most studies have found that the minimum acceptable nucleated cell dose should be between 1.5 X 10(7) and 2.0 X 10(7) nucleated cells per kilogram of body weight to reduce the time to myeloid recovery and increase the probability of engraftment. For some patients who have indications for hematopoietic cell transplants and for whom no other graft source except cord blood is available, it is difficult to decide whether they can receive cord blood grafts containing lower cell doses. In our study, patients who received cord blood grafts containing 1.0 X 10(7) to 2.0 X 10(7) cells/kg (n = 7) exhibited slower neutrophil and platelet recoveries compared with patients who received grafts containing total nucleated cell doses of 2.0 X 10(7) cells/kg and above (n = 93); however, 4 of those low-cell-dose recipients survived with a longer follow-up. Based on these preliminary results, cord blood grafts containing less than 2.0 X 101 cells/kg may be useful for cases where no grafts with higher cell doses or other stem cell sources are available.