title: Acute graft-versus-host disease after unrelated donor umbilical cord blood transplantation: analysis of risk factors.
abstract: Acute graft-versus-host disease (GVHD) occurs less frequently after umbilical cord blood transplantation (UCBT). More recent investigations include the use of 2 partially human leukocyte antigen (HLA)-matched UCB units, or double UCB graft, to meet the minimum cell-dose requirement. The purpose of this analysis was to assess the relative risk of acute GVHD in 265 consecutive patients receiving transplants with UCB graft composed of 1 (n = 80) or 2 (n = 185) units. The incidence of grade III-IV acute GVHD was similar between cohorts. However, the incidence of grade II-IV acute GVHD was higher among double UCBT recipients (58 vs 39%, P < .01). Three risk factors for grade II-IV acute GVHD were identified in multiple regression analysis: use of 2 UCB units, use of nonmyeloablative conditioning, and absence of antithymocyte globulin in the conditioning regimen. Transplantation-related mortality (TRM) at 1 year, however, was significantly lower after double UCBT (24 vs 39%, P = .02) even if recipients had grade II-IV acute GVHD (20 vs 39%, P = .05). These data suggest that, despite a higher incidence of grade II acute GVHD in recipients of 2 partially HLA-matched UCB units, there is no adverse effect on TRM. This study is registered at (http://www.clinicaltrials.gov) under the identifiers NCT00305682 and NCT00309842.
authors.affiliation: Blood and Marrow Transplant Program, University of Minnesota Medical School, Minneapolis, MN 55455, USA. macmi002@umn.edu
authors.forename: Margaret L
authors.initials: ML
authors.lastname: MacMillan
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: Claudio G
authors.initials: CG
authors.lastname: Brunstein
authors.forename: Qing
authors.initials: Q
authors.lastname: Cao
authors.forename: Todd E
authors.initials: TE
authors.lastname: DeFor
authors.forename: Michael R
authors.initials: MR
authors.lastname: Verneris
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Blazar
authors.forename: John E
authors.initials: JE
authors.lastname: Wagner
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001782:Blood Donors; D001803:Blood Transfusion / Q000401:mortality; D002648:Child; D015331:Cohort Studies; D005260:Female; D005312:Fetal Blood / Q000637:transplantation*; D006086:Graft vs Host Disease / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D055815:Young Adult