title: Graft-versus-host disease and survival after cord blood transplantation for acute leukemia: a comparison of Japanese versus White populations.
abstract: An earlier report identified higher risks of acute and chronic graft-versus-host disease (GVHD) in White children compared with the Japanese after HLA-matched sibling transplantations. The current analysis explored whether racial differences are associated with GVHD risks after unrelated umbilical cord blood transplantation. Included are patients of Japanese descent (n = 257) and Whites (n = 260; 168 of 260 received antithymocyte globulin [ATG]). Transplants were performed in the United States or Japan between 2000 and 2009; patients were aged 16 years or younger, had acute leukemia, were in complete remission, and received a myeloablative conditioning regimen. The median ages of the Japanese and Whites who received ATG were younger at 5 years compared with 8 years for Whites who did not receive ATG. In all groups most transplants were mismatched at 1 or 2 HLA loci. Multivariate analysis found no differences in risks of acute GVHD between the Japanese and Whites. However, chronic GVHD was higher in Whites who did not receive ATG compared with the Japanese (hazard ratio, 2.16; P < .001), and treatment-related mortality was higher in Whites who received ATG compared with the Japanese (relative risk, 1.81; P = .01). Nevertheless, there were no significant differences in overall survival between the 3 groups.
authors: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: ykuwatsuka@med.nagoya-u.ac.jp.
authors: Yachiyo
authors: Y
authors: Kuwatsuka
authors: Department of HSCT Data Management and Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors: Yoshiko
authors: Y
authors: Atsuta
authors: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Mary M
authors: MM
authors: Horowitz
authors: Department of Pediatrics, National Kyushu Cancer Center, Fukuoka, Japan.
authors: Jiro
authors: J
authors: Inagaki
authors: Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors: Junya
authors: J
authors: Kanda
authors: Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross, Nagoya First Hospital, Nagoya, Japan.
authors: Koji
authors: K
authors: Kato
authors: Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan.
authors: Katsuyoshi
authors: K
authors: Koh
authors: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Mei-Jie
authors: MJ
authors: Zhang
authors: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors: Mary
authors: M
authors: Eapen
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D044466:Asian People; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D006086:Graft vs Host Disease / Q000208:ethnology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000208:ethnology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D019653:Myeloablative Agonists / Q000627:therapeutic use; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods* / Q000401:mortality; D014184:Transplantation, Homologous; D061349:Unrelated Donors; D044465:White People
chemical_list: D000961:Antilymphocyte Serum; D019653:Myeloablative Agonists
keywords: GVHD; Umbilical cord blood transplantation