Combined effect of total nucleated cell dose and HLA match on transplantation outcome in 1061 cord blood recipients with hematologic malignancies
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Open Access
- 4 March 2010
- journal article
- Published by American Society of Hematology in Blood
- Vol. 115 (9), 1843-1849
- https://doi.org/10.1182/blood-2009-07-231068
Abstract
Both total nucleated cell (TNC) dose and human leukocyte antigen (HLA)–match affect the outcome of cord blood (CB) transplantation. However, how to prioritize these characteristics in unit selection is not established. Therefore, we analyzed the outcomes of 1061 patients who received single-unit myeloablative CB transplantation for leukemia or myelodysplasia. TNC dose and HLA-match each affected survival via their effect on transplant-related mortality (TRM); neither was associated with relapse. Therefore, TRM was the focus of multivariate analyses combining dose and HLA-match. Compared with our 1 HLA-mismatch (MM) reference group with TNC 2.5 to 4.9 × 107/kg, recipients of 0 MM units had the lowest TRM regardless of dose (relative risk [RR] = 0.4, P = .019). TRM for recipients of 1- or 2-MM units with TNC 5.0 × 107/kg or greater was similar to the reference group (RR = 0.8, P = .391 and RR = 1.0, P = .847) despite their greater dose. Recipients of 2 MM units with TNC 2.5 to 4.9 × 107/kg had a greater TRM (RR = 1.5, P = .014), and those with 1 or 2 MM and TNC less than 2.5 × 107/kg or 3 MM did substantially worse. These findings support new unit selection criteria that take into account both TNC dose and HLA-match and have important implications for the size of the global CB inventory needed to find an optimum CB graft.Keywords
This publication has 14 references indexed in Scilit:
- Results of the Cord Blood Transplantation Study (COBLT): clinical outcomes of unrelated donor umbilical cord blood transplantation in pediatric patients with hematologic malignanciesBlood, 2008
- A Scheme for Defining Cause of Death and Its Application in the T Cell Depletion TrialTransplantation and Cellular Therapy, 2007
- Outcomes of transplantation of unrelated donor umbilical cord blood and bone marrow in children with acute leukaemia: a comparison studyThe Lancet, 2007
- Expanding the role of umbilical cord blood transplantationBritish Journal of Haematology, 2007
- Immune reconstitution after unrelated cord blood transplantationCytotherapy, 2007
- Umbilical Cord Blood (UCB) Transplantation: An Alternative to the Use of Unrelated Volunteer Donors?Hematology, 2007
- Donor selection for unrelated cord blood transplantsCurrent Opinion in Immunology, 2006
- Hematopoietic Engraftment and Survival in Adult Recipients of Umbilical-Cord Blood from Unrelated DonorsThe New England Journal of Medicine, 2001
- Outcomes among 562 Recipients of Placental-Blood Transplants from Unrelated DonorsThe New England Journal of Medicine, 1998
- IBMTR Severity INDEX FOR GRADING ACUTE GRAFT‐VERSUS‐HOST DISEASE: RETROSPECTIVE COMPARISON WITH GLUCKSBERG GRADEBritish Journal of Haematology, 1997