Effect of HLA-matching recipients to donor noninherited maternal antigens on outcomes after mismatched umbilical cord blood transplantation for hematologic malignancy. Biol Blood Marrow Transplant 2012 Dec;18(12):1890-6
Date
07/21/2012Pubmed ID
22814031Pubmed Central ID
PMC3826155DOI
10.1016/j.bbmt.2012.07.010Scopus ID
2-s2.0-84869090988 (requires institutional sign-in at Scopus site) 66 CitationsAbstract
Transplantation-related mortality (TRM) is high after HLA-mismatched umbilical cord blood (UCB) transplantation (UCBT). In utero, exposure to noninherited maternal antigen (NIMA) is recognized by the fetus, which induces T regulator cells to that haplotype. It is plausible that UCBTs in which recipients are matched to donor NIMAs may alleviate some of the excess mortality associated with this treatment. To explore this concept, we used marginal matched-pair Cox regression analysis to compare outcomes in 48 NIMA-matched UCBTs (ie, the NIMA of the donor UCB unit matched to the patient) and in 116 non-NIMA-matched UCBTs. All patients had a hematologic malignancy and received a single UCB unit. Cases and controls were matched on age, disease, disease status, transplantation-conditioning regimen, HLA match, and infused cell dose. TRM was lower after NIMA-matched UCBTs compared with NIMA-mismatched UCBTs (relative risk, 0.48; P = .05; 18% versus 32% at 5 years posttransplantation). Consequently, overall survival was higher after NIMA-matched UCBT. The 5-year probability of overall survival was 55% after NIMA-matched UCBTs versus 38% after NIMA-mismatched UCBTs (P = .04). When faced with the choice of multiple HLA-mismatched UCB units containing adequate cell doses, selecting an NIMA-matched UCB unit may improve survival after mismatched UCBT.
Author List
Rocha V, Spellman S, Zhang MJ, Ruggeri A, Purtill D, Brady C, Baxter-Lowe LA, Baudoux E, Bergamaschi P, Chow R, Freed B, Koegler G, Kurtzberg J, Larghero J, Lecchi L, Nagler A, Navarrette C, Prasad V, Pouthier F, Price T, Ratanatharathorn V, van Rood JJ, Horowitz MM, Gluckman E, Eapen M, Eurocord-European Blood and Marrow Transplant Group and the Center for International Blood and Marrow Transplant ResearchAuthors
Mary Eapen MBBS, DCh, MRCPI, MS Professor in the Medicine department at Medical College of WisconsinMary M. Horowitz MD, MS Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentCord Blood Stem Cell Transplantation
Female
Fetal Blood
HLA Antigens
Humans
Leukemia
Lymphoma
Male
Survival Rate
Tissue Donors
Treatment Outcome