title: High-resolution HLA matching in double-umbilical-cord-blood reduced-intensity transplantation in adults.
abstract: BACKGROUND
  Double-cord-blood transplantation (DCBT) offers an option for patients receiving reduced-intensity transplants. These unique transplants have two donors, both of whom are usually HLA mismatched at one to two loci.
  
  
  METHODS
  Fifty-three patients were recipients of a reduced-intensity DCBT. Cords were at least 4/6 allele-level HLA-A, -B, and -DR match with the patient and each other with a minimum combined cell dose of more than 3.7 x 10(7) total nucleated cells per kg. Twenty-one patients received cyclosporine/mycophenolate mofetil and 32 patients received sirolimus/tacrolimus (SIR/TAC) for graft-versus-host disease prophylaxis. The effect of allele level HLA typing on clinical endpoints of overall survival (OS), disease-free survival (DFS), engraftment, and acute graft-versus-host disease (aGVHD) were assessed.
  
  
  RESULTS
  Neutrophil (p = 0.001) engraftment and platelet engraftment (p = 0.027) were significantly faster in patients who have closer Class I (HLA-A, -B, -C) matching. Neutrophil engraftment was faster in patients who had closer HLA-B matching to their combined cords (p = 0.007). There was a low incidence of aGVHD overall, especially in the SIR/TAC group. Class I HLA matching had no effect on aGVHD. HLA-DR and -DQ had no effect on engraftment or aGVHD.
  
  
  CONCLUSIONS
  Class I allele matching, and HLA-B matching specifically, were associated with faster neutrophil engraftment. High-resolution HLA matching did not affect OS or DFS.
authors.affiliation: Puget Sound Blood Center, Seattle, Washington 98104, USA. meghand@psbc.org
authors.forename: Meghan
authors.initials: M
authors.lastname: Delaney
authors.forename: Corey S
authors.initials: CS
authors.lastname: Cutler
authors.forename: Richard L
authors.initials: RL
authors.lastname: Haspel
authors.forename: Beow Y
authors.initials: BY
authors.lastname: Yeap
authors.forename: Steven L
authors.initials: SL
authors.lastname: McAfee
authors.forename: Bimalangshu R
authors.initials: BR
authors.lastname: Dey
authors.forename: Eyal
authors.initials: E
authors.lastname: Attar
authors.forename: Grace
authors.initials: G
authors.lastname: Kao
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Alyea
authors.forename: John
authors.initials: J
authors.lastname: Koreth
authors.forename: Vincent T
authors.initials: VT
authors.lastname: Ho
authors.forename: Susan
authors.initials: S
authors.lastname: Saidman
authors.forename: Deborah
authors.initials: D
authors.lastname: Liney
authors.forename: Doreen
authors.initials: D
authors.lastname: Sese
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Soiffer
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Spitzer
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.forename: Karen K
authors.initials: KK
authors.lastname: Ballen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001792:Blood Platelets; D002452:Cell Count; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D005312:Fetal Blood / Q000166:cytology / Q000276:immunology; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000517:prevention & control; D006648:Histocompatibility / Q000502:physiology*; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D009504:Neutrophils; D016019:Survival Analysis; D014019:Tissue Donors; D014181:Transplantation Immunology; D055815:Young Adult