High-resolution HLA matching in double-umbilical-cord-blood reduced-intensity transplantation in adults.
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.
Delaney
Meghan
M
Puget Sound Blood Center, Seattle, Washington 98104, USA. meghand@psbc.org
Cutler
Corey S
CS
Haspel
Richard L
RL
Yeap
Beow Y
BY
McAfee
Steven L
SL
Dey
Bimalangshu R
BR
Attar
Eyal
E
Kao
Grace
G
Alyea
Edwin P
EP
Koreth
John
J
Ho
Vincent T
VT
Saidman
Susan
S
Liney
Deborah
D
Sese
Doreen
D
Soiffer
Robert J
RJ
Spitzer
Thomas R
TR
Antin
Joseph H
JH
Ballen
Karen K
KK
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