Unrelated cord blood transplantation vs related transplantation with HLA 1-antigen mismatch in the graft-versus-host direction.
Little information is available regarding whether an unrelated cord blood (UCB) unit or a related donor with a 1-antigen mismatch at the HLA-A, HLA-B or HLA-DR locus in the graft-versus-host direction (RD/1AG-MM-GVH) should be selected as an alternative donor for patients without an HLA-matched related/unrelated donor. Therefore, we conducted a retrospective study using national registry data on patients with leukemia or myelodysplastic syndrome who received transplantation using a single UCB (n=2288) unit or an RD/1AG-MM-GVH (n=525). We found that the survival rate in the UCB group was comparable to that in the RD/1AG-MM-GVH group, although the RD/1AG-MM-GVH group with an HLA-B mismatch showed significantly higher overall and non-relapse mortality. Neutrophil and platelet engraftment were significantly faster, whereas the incidence of acute or chronic graft-versus-host disease (GVHD) was significantly higher in the RD/1AG-MM-GVH group. The incidence of acute or chronic GVHD in the RD/1AG-MM-GVH group with in vivo T-cell depletion was comparable to that in the UCB group, which translated into a trend toward better overall survival, regardless of the presence of an HLA-B mismatch. In conclusion, UCB and RD/1AG-MM-GVH are comparable for use as an alternative donor, except for RD/1AG-MM-GVH involving an HLA-B mismatch.
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan. jkandajp@gmail.com
J
J
Kanda
T
T
Ichinohe
S
S
Kato
N
N
Uchida
S
S
Terakura
T
T
Fukuda
M
M
Hidaka
Y
Y
Ueda
T
T
Kondo
S
S
Taniguchi
S
S
Takahashi
T
T
Nagamura-Inoue
J
J
Tanaka
Y
Y
Atsuta
K
K
Miyamura
Y
Y
Kanda
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D005260:Female; D005312:Fetal Blood / Q000276:immunology / Q000637:transplantation*; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology*; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007938:Leukemia / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning; D061349:Unrelated Donors; D055815:Young Adult
D006680:HLA Antigens