Acute graft-versus-host disease after unrelated donor umbilical cord blood transplantation: analysis of risk factors.
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.
MacMillan
Margaret L
ML
Blood and Marrow Transplant Program, University of Minnesota Medical School, Minneapolis, MN 55455, USA. macmi002@umn.edu
Weisdorf
Daniel J
DJ
Brunstein
Claudio G
CG
Cao
Qing
Q
DeFor
Todd E
TE
Verneris
Michael R
MR
Blazar
Bruce R
BR
Wagner
John E
JE
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