Better allele-level matching improves transplant-related mortality after double cord blood transplantation.

Haematologica 2015 Oct 6;100(10):1361-70. Epub 2015 Aug 6.

Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Cord blood transplant requires less stringent human leukocyte antigen matching than unrelated donors. In 133 patients with hematologic malignancies who engrafted after double cord blood transplantation with a dominant unit, we studied the effect of high resolution testing at 4 loci (-A, -B, -C, -DRB1) for its impact on 2-year transplant-related mortality. Ten percent of the dominant cord blood units were matched at 7-8/8 alleles using HLA-A, -B, -C, and -DRB1; 25% were matched at 6/8, 40% at 5/8, and 25% at 4/8 or less allele. High resolution typing at 4 loci showed that there was no 2-year transplant-related mortality in 7-8/8 matched patients. Patients with 5-6/8 matched dominant cord blood units had 2-year transplant-related mortality of 39% while patients with 4/8 or less matched units had 60%. Multivariate regression analyses confirmed the independent effect of high resolution typing on the outcome when adjusted for age, diagnosis, CD34(+) cell dose infused, graft manipulation and cord to cord matching. The worst prognostic group included patients aged over 32 years with 4/8 or less matched cord blood units compared with patients who were either younger than 32 years old independent of allele-level matching, or aged over 32 years but with 5-6/8 matched cord blood units (Hazard Ratio 2.2; 95% confidence interval: 1.3-3.7; P<0.001). Patients with 7-8/8 matched units remained the group with the best prognosis. Our data suggest that high resolution typing at 4 loci and selecting cord blood units matched at at least 5/8 alleles may reduce transplant-related mortality after double cord blood transplantation.

Download full-text PDF

Source
http://dx.doi.org/10.3324/haematol.2015.127787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4591769PMC
October 2015
48 Reads
6 Citations
5.870 Impact Factor

Publication Analysis

Top Keywords

cord blood
28
transplant-related mortality
16
blood units
16
2-year transplant-related
12
high resolution
12
cord
9
dominant cord
8
resolution typing
8
4/8 matched
8
5-6/8 matched
8
aged years
8
double cord
8
blood transplantation
8
matched cord
8
allele-level matching
8
matched
7
blood
7
patients
6
units
5
39% patients
4

Similar Publications