title: Human herpesvirus 6 reactivation before engraftment is strongly predictive of graft failure after double umbilical cord blood allogeneic stem cell transplantation in adults.
abstract: Our main objective was to determine new factors associated with engraftment and single-unit predominance after double umbilical cord blood (UCB) allogeneic stem-cell transplantation. Engraftment occurred in 78% of cases in this retrospective study including 77 adult patients. Three-year overall survival, disease-free survival, relapse incidence, and nonrelapse mortality were 55 ± 6%, 44 ± 6%, 33 ± 5%, and 23 ± 4%, respectively. In multivariate analysis, Human herpesvirus 6 reactivation during aplasia (hazard ratio [HR] = 2.63; 95% confidence interval [CI]: 1.64-4.17; p < 0.001), younger recipient age (<53 years) (HR = 1.97; 95% CI: 1.16-3.35; p = 0.012), and lower human leukocyte antigen matching between the two units (3 of 6 or 4 of 6) (HR = 2.09; 95% confidence interval: 1.22-3.59; p = 0.013) were the three factors independently associated with graft failure. Also, factors independently predicting the losing UCB unit were younger age of the UCB unit (odds ratio [OR] = 1.01; 95% CI: 1-1.02; p = 0.035), lower CD34(+) cell dose contained in the UCB unit (≤ 0.8 × 10(5)/kg) (OR = 2.55; 95% CI: 1.05-6.16; p = 0.04), and presence of an ABO incompatibility between the UCB unit and the recipient (OR = 2.53; 95% CI: 1.15-5.53; p = 0.02). Thus, Human herpesvirus 6 reactivation during aplasia, lower unit-unit human leukocyte antigen matching, and younger UCB unit age, as new unfavorable predictive factors, may represent new parameters to take into account after double UCB allogeneic stem-cell transplantation in adults. These results need to be confirmed prospectively, as they may influence unit selections and patient outcomes.
authors: Centre Hospitalier et Universitaire de Nantes, Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie, Nantes, France.
authors: Amandine
authors: A
authors: Le Bourgeois
authors: Hôpital Saint Antoine, Hématologie Clinique, Paris, France.
authors: Myriam
authors: M
authors: Labopin
authors: Centre Hospitalier et Universitaire de Nantes, Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie, Nantes, France.
authors: Thierry
authors: T
authors: Guillaume
authors: Centre Hospitalier et Universitaire de Nantes, Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie, Nantes, France.
authors: Jacques
authors: J
authors: Delaunay
authors: Université de Nantes et Institut National de la Sante et de la Recherche (INSERM) U1064, Nantes, France; Bio-Statistics, Pharmacoepidemiology & Human Sciences Research Laboratory, University of Nantes, Nantes, France.
authors: Yohann
authors: Y
authors: Foucher
authors: Centre Hospitalier et Universitaire de Nantes, Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie, Nantes, France.
authors: Benoit
authors: B
authors: Tessoulin
authors: Centre Hospitalier et Universitaire de Nantes, Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie, Nantes, France; Université de Nantes et INSERM Centre Régional de Recherche en Cancérologie Nantes/Angers Unite Mixte de Recherche 892, Nantes, France.
authors: Florent
authors: F
authors: Malard
authors: Centre Hospitalier et Universitaire de Nantes, Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie, Nantes, France.
authors: Sameh
authors: S
authors: Ayari
authors: Centre Hospitalier et Universitaire de Nantes, Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie, Nantes, France.
authors: Pierre
authors: P
authors: Peterlin
authors: Unité d'Ingénierie Cellulaire, Etablissement Francais du Sang (EFS) Pays de la Loire, Nantes, France.
authors: Sophie
authors: S
authors: Derenne
authors: Laboratoire d'Histocompatibilité et d'Immunogénétique, EFS Pays de la Loire, Nantes, France.
authors: Patricia
authors: P
authors: Herry
authors: Laboratoire d'Histocompatibilité et d'Immunogénétique, EFS Pays de la Loire, Nantes, France.
authors: Anne
authors: A
authors: Cesbron
authors: Laboratoire d'Histocompatibilité et d'Immunogénétique, EFS Pays de la Loire, Nantes, France; Laboratoire EA4271, Université de Nantes and EFS Pays de la Loire, Nantes, France.
authors: Katia
authors: K
authors: Gagne
authors: Département de Biologie/Hématologie, Centre Hospitalier et Universitaire de Nantes, Nantes, France.
authors: Laurence
authors: L
authors: Lodé
authors: Laboratoire EA4271, Université de Nantes and EFS Pays de la Loire, Nantes, France; Département de Virologie, Centre Hospitalier et Universitaire de Nantes, Nantes, France.
authors: Marina
authors: M
authors: Illiaquer
authors: Laboratoire EA4271, Université de Nantes and EFS Pays de la Loire, Nantes, France; Département de Virologie, Centre Hospitalier et Universitaire de Nantes, Nantes, France.
authors: Berthe-Marie
authors: BM
authors: Imbert-Marcille
authors: Centre Hospitalier et Universitaire de Nantes, Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie, Nantes, France.
authors: Steven
authors: S
authors: Le Gouill
authors: Centre Hospitalier et Universitaire de Nantes, Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie, Nantes, France.
authors: Philippe
authors: P
authors: Moreau
authors: Hôpital Saint Antoine, Hématologie Clinique, Paris, France.
authors: Mohamad
authors: M
authors: Mohty
authors: Centre Hospitalier et Universitaire de Nantes, Hématologie Clinique, Centre d'Investigation Clinique en Cancérologie, Nantes, France; Université de Nantes et INSERM Centre Régional de Recherche en Cancérologie Nantes/Angers Unite Mixte de Recherche 892, Nantes, France. Electronic address: patrice.chevallier@chu-nantes.fr.
authors: Patrice
authors: P
authors: Chevallier
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000821:virology*; D006086:Graft vs Host Disease / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000821:virology*; D019337:Hematologic Neoplasms / Q000150:complications* / Q000276:immunology / Q000401:mortality / Q000628:therapy; D015654:Herpesvirus 6, Human / Q000502:physiology*; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D019349:Roseolovirus Infections / Q000150:complications* / Q000276:immunology / Q000401:mortality / Q000628:therapy; D016019:Survival Analysis; D014184:Transplantation, Homologous; D014775:Virus Activation; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System