Factors associated with outcomes of unrelated cord blood transplant: guidelines for donor choice.
OBJECTIVE
Optimizing cord blood donor selection based mainly on cell dose and human leukocyte antigen (HLA) disparities may further improve results of unrelated cord blood transplants (UCBT).


RESULTS
We analyzed 550 UCBTs for hematologic malignancies reported to the Eurocord Registry. Main outcomes and prognostic factors were analyzed in univariable and multivariable analyses incorporating center and period effects and using death and relapse as competitive risks for nonfatal endpoints. Nucleated cell (NC) dose before freezing and number of HLA disparities had a significant influence on outcome. Cumulative incidence (CI) of neutrophil and platelet recovery was associated with the number of HLA mismatches, number of NC before freezing, and use of granulocyte colony-stimulating factor. Coexistence of HLA class I and II disparities and high CD34 cell dose in the graft were associated with graft-vs-host disease grades III-IV. CI of disease relapse was higher in matched transplants showing a graft-vs-leukemia effect increased in HLA-mismatched transplants. Overall 3-year survival was 34.4%. Prognostic factors for survival were recipient age, gender, and disease status.


CONCLUSIONS
Our results provide indications for a better choice of cord blood units according to cord blood cell content and HLA.
Gluckman
Eliane
E
Bone Marrow Transplant Unit and Eurocord Registry, Laboratory of Clinical Research on Cell Therapy, Saint Louis Hospital AP-HP University Paris VII, Paris, France. elaine.gluckman@sls.ap-hop-paris.fr
Rocha
Vanderson
V
Arcese
William
W
Michel
Gérard
G
Sanz
Guillermo
G
Chan
Ka-Wah
KW
Takahashi
Tsuneo A
TA
Ortega
Juan
J
Filipovich
Alexandra
A
Locatelli
Franco
F
Asano
Shigetaka
S
Fagioli
Franca
F
Vowels
Marcus
M
Sirvent
Anne
A
Laporte
Jean-Philippe
JP
Tiedemann
Karin
K
Amadori
Sergio
S
Abecassis
Manuel
M
Bordigoni
Pierre
P
Diez
Blanca
B
Shaw
Peter J
PJ
Vora
Ajay
A
Caniglia
Maurizio
M
Garnier
Federico
F
Ionescu
Irina
I
Garcia
Joan
J
Koegler
Gesine
G
Rebulla
Paolo
P
Chevret
Sylvie
S
D000293:Adolescent; D000328:Adult; D018952:Antigens, CD34 / Q000032:analysis; D001772:Blood Cell Count; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D020544:Graft vs Leukemia Effect / Q000276:immunology; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology; D006680:HLA Antigens / Q000276:immunology; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D006648:Histocompatibility; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D015993:Life Tables; D008297:Male; D009436:Neural Tube Defects / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000401:mortality / Q000706:statistics & numerical data; D016896:Treatment Outcome
D018952:Antigens, CD34; D006680:HLA Antigens; D016179:Granulocyte Colony-Stimulating Factor