title: Influence of infused cell dose and HLA match on engraftment after double-unit cord blood allografts.
abstract: The influence of cell dose and human leukocyte antigen (HLA) match on double-unit cord blood (CB) engraftment is not established. Therefore, we analyzed the impact of cell dose and high-resolution HLA match on neutrophil engraftment in 84 double-unit CB transplant recipients. The 94% sustained engraftment rate was accounted for by 1 unit in nearly all patients. Higher CD3(+) cell doses (P = .04) and percentage of CD34(+) cell viability (P = .008) were associated with unit dominance. After myeloablative conditioning, higher dominant unit total nucleated cell (TNC), CD34(+) cell, and colony-forming unit doses were associated with higher sustained engraftment and faster neutrophil recovery (P = .07, P = .0008, and P < .0001, respectively). Total infused TNC (P = .0007) and CD3(+) cell doses (P = .001) also significantly influenced engraftment. At high-resolution extensive donor-recipient HLA disparity was frequent, but had no influence on engraftment (P = .66), or unit dominance (P = .13). Although the unit-unit HLA match also did not affect sustained engraftment (P = 1.0), recipients of units closely (7-10 to 10-10) HLA-matched to each other were more likely to demonstrate initial engraftment of both units (P < .0001). Our findings have important implications for unit selection and provide further insight into double-unit biology.
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Avery
authors.forename: Weiji
authors.initials: W
authors.lastname: Shi
authors.forename: Marissa
authors.initials: M
authors.lastname: Lubin
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Gonzales
authors.forename: Glenn
authors.initials: G
authors.lastname: Heller
authors.forename: Hugo
authors.initials: H
authors.lastname: Castro-Malaspina
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Kernan
authors.forename: Andromachi
authors.initials: A
authors.lastname: Scaradavou
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Barker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002452:Cell Count; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000032:analysis; D006412:Hematopoietic Stem Cells / Q000166:cytology*; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology; D014184:Transplantation, Homologous / Q000276:immunology; D055815:Young Adult
chemical_list: D006680:HLA Antigens