The effect of inter-unit HLA matching in double umbilical cord blood transplantation for acute leukemia. Haematologica 2017 May;102(5):941-947
Date
01/28/2017Pubmed ID
28126967Pubmed Central ID
PMC5477613DOI
10.3324/haematol.2016.158584Scopus ID
2-s2.0-85018992448 (requires institutional sign-in at Scopus site) 14 CitationsAbstract
The effects of inter-unit HLA-match on early outcomes with regards to double cord blood transplantation have not been established. Therefore, we studied the effect of inter-unit HLA-mismatching on the outcomes of 449 patients with acute leukemia after double cord blood transplantation. Patients were divided into two groups: one group that included transplantations with inter-unit mismatch at 2 or less HLA-loci (n=381) and the other group with inter-unit mismatch at 3 or 4 HLA-loci (n=68). HLA-match considered low resolution matching at HLA-A and -B loci and allele-level at HLA-DRB1, the accepted standard for selecting units for double cord blood transplants. Patients', disease, and transplant characteristics were similar in the two groups. We observed no effect of the degree of inter-unit HLA-mismatch on neutrophil (Hazard Ratio 1.27, P=0.11) or platelet (Hazard Ratio 0.1.13, P=0.42) recovery, acute graft-versus-host disease (Hazard Ratio 1.17, P=0.36), treatment-related mortality (Hazard Ratio 0.92, P=0.75), relapse (Hazard Ratio 1.18, P=0.49), treatment failure (Hazard Ratio 0.99, P=0.98), or overall survival (Hazard Ratio 0.98, P=0.91). There were no differences in the proportion of transplants with engraftment of both units by three months (5% after transplantation of units with inter-unit mismatch at ≤2 HLA-loci and 4% after transplantation of units with inter-unit mismatch at 3 or 4 HLA-loci). Our observations support the elimination of inter-unit HLA-mismatch criterion when selecting cord blood units in favor of optimizing selection based on individual unit characteristics.
Author List
Brunstein C, Zhang MJ, Barker J, St Martin A, Bashey A, de Lima M, Dehn J, Hematti P, Perales MA, Rocha V, Territo M, Weisdorf D, Eapen MAuthors
Mary Eapen MBBS, DCh, MRCPI, MS Professor in the Medicine department at Medical College of WisconsinPeiman Hematti MD Professor in the Medicine department at Medical College of Wisconsin
Mei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Acute DiseaseAdult
Cord Blood Stem Cell Transplantation
Female
Graft vs Host Disease
HLA-A Antigens
HLA-B Antigens
HLA-DRB1 Chains
Histocompatibility Testing
Humans
Kaplan-Meier Estimate
Leukemia, Myeloid
Male
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Proportional Hazards Models