TY - JOUR
T1 - Better allele-level matching improves transplant-related mortality after double cord blood transplantation
AU - Oran, Betül
AU - Cao, Kai
AU - Saliba, Rima M.
AU - Rezvani, Katayoun
AU - de Lima, Marcos
AU - Ahmed, Sairah
AU - Hosing, Chitra M.
AU - Popat, Uday R.
AU - Carmazzi, Yudith
AU - Kebriaei, Partow
AU - Nieto, Yago
AU - Rondon, Gabriela
AU - Willis, Dana
AU - Shah, Nina
AU - Parmar, Simrit
AU - Olson, Amanda
AU - Moore, Brandt
AU - Marin, David
AU - Mehta, Rohtesh
AU - Fernández-Viña, Marcelo
AU - Champlin, Richard E.
AU - Shpall, Elizabeth J.
N1 - Publisher Copyright:
© 2015 Ferrata Storti Foundation.
PY - 2015/10/2
Y1 - 2015/10/2
N2 - 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 transplantrelated mortality after double cord blood transplantation.
AB - 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 transplantrelated mortality after double cord blood transplantation.
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U2 - 10.3324/haematol.2015.127787
DO - 10.3324/haematol.2015.127787
M3 - Article
C2 - 26250579
AN - SCOPUS:84943339377
SN - 0390-6078
VL - 100
SP - 1361
EP - 1370
JO - Haematologica
JF - Haematologica
IS - 10
ER -