Impact of HLA disparity in the graft-versus-host direction on engraftment in adult patients receiving reduced-intensity cord blood transplantation.
Delayed engraftment or graft failure is one of the major complications after cord blood transplantation (CBT). To investigate factors impacting engraftment, we conducted a retrospective analysis of adult patients who underwent reduced-intensity CBT at our institute, in which preparative regimens mainly consisted of fludarabine, melphalan, and total body irradiation with graft-versus-host (GVH) disease prophylaxis using single calcineurin inhibitors. Among 152 evaluable patients, the cumulative incidence of neutrophil engraftment was 89%. High total nucleated cell and CD34(+) cell dose were associated with the faster speed and higher probability of engraftment. In addition, the degree of human leukocyte antigen (HLA) mismatch in the GVH direction was inversely associated with engraftment kinetics, whereas no statistically significant association was observed with the degree of HLA mismatch in the host-versus-graft direction. Similarly, the number of HLA class I antigens mismatched in the GVH direction, but not in the host-versus-graft direction, showed a negative correlation with engraftment kinetics. HLA disparity did not have significant impact on the development of GVH disease or survival. This result indicates the significant role of HLA disparity in the GVH direction in the successful engraftment, raising the novel mechanism responsible for graft failure in CBT.
Matsuno
Naofumi
N
Department of Hematology, Toranomon Hospital, Tokyo, Japan.
Wake
Atsushi
A
Uchida
Naoyuki
N
Ishiwata
Kazuya
K
Araoka
Hideki
H
Takagi
Shinsuke
S
Tsuji
Masanori
M
Yamamoto
Hisashi
H
Kato
Daisuke
D
Matsuhashi
Yoshiko
Y
Seo
Sachiko
S
Masuoka
Kazuhiro
K
Miyakoshi
Shigesaburo
S
Makino
Shigeyoshi
S
Yoneyama
Akiko
A
Kanda
Yoshinobu
Y
Taniguchi
Shuichi
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005312:Fetal Blood / Q000637:transplantation*; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality / Q000628:therapy; D006680:HLA Antigens / Q000032:analysis / Q000276:immunology; D019337:Hematologic Neoplasms / Q000175:diagnosis / Q000276:immunology / Q000628:therapy; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D055815:Young Adult
D006680:HLA Antigens