title: Impact of the source of hematopoietic stem cell in unrelated transplants: comparison between 10/10, 9/10-HLA matched donors and cord blood.
abstract: In absence of available matched-related or unrelated donor (MUD), mismatched unrelated donors (MMUD) and unrelated cord blood (UCB) are both considered to be suitable donors, with similar post-transplant overall survival. In most of these retrospective comparisons, HLA typing of adult donors was performed at eight loci. The aim of this study was to compare the outcome of patients transplanted from UCB (N = 64) with those transplanted from 9/10-HLA MMUD (N = 84) or 10/10-HLA MUD (N = 196). In multivariate analysis, UCB was associated with less Grade II-IV acute GVHD in comparison with MUD (aHR 1.97, 95% CI 1.19-3.27, P = 0.009) and MMUD transplants (aHR 1.79, 95% CI 1.02-3.15, P = 0.042), while the cumulative incidence of chronic GVHD was not significantly different between the three groups. Overall survival (OS), non-relapse mortality, and relapse were not different between MMUD and UCB transplantation, whereas OS was impaired after UCB in comparison with MUD (aHR 0.65, 95% CI 0.43-0.99, P = 0.043). Factors also impacting OS were the donor/recipient CMV serostatus (Donor-/Recipient+ aHR 1.76, 95% CI 1.23-2.52, P = 0.002 compared with D-/R-), the donor/recipient gender combination (Female/Male versus other combinations aHR 1.57, 95% CI 1.11-2.22, P = 0.012) and disease risk (aHR 1.58, 95% CI 1.05-2.38, P = 0.027 for high vs. low risk disease). Our data confirm that UCB and 9/10-HLA MMUD are both relevant alternative options when no 10/10-HLA donor is available. Donor/recipient gender combination and CMV serostatus had a significant impact on survival and may be taken into account, along with donor type, in the setting of MMUD and UCB transplants.
authors.affiliation: Laboratoire D'immunologie Et Histocompatibilité, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: Clémence
authors.initials: C
authors.lastname: Granier
authors.affiliation: Service De Biostatistique Et D'information Médicale, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Biard
authors.affiliation: Laboratoire D'immunologie Et Histocompatibilité, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: Emeline
authors.initials: E
authors.lastname: Masson
authors.affiliation: Service De Biostatistique Et D'information Médicale, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Porcher
authors.affiliation: Service D'hématologie Greffe, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: Régis
authors.initials: R
authors.lastname: Peffault de Latour
authors.affiliation: Service D'hématologie Greffe, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.affiliation: Unité Hématologie Adolescents Jeunes Adultes, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Boissel
authors.affiliation: Service D'hématologie Greffe, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: Alienor
authors.initials: A
authors.lastname: Xhaard
authors.affiliation: Service D'hématologie Greffe, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Ribaud
authors.affiliation: Unité Hématologie Adolescents Jeunes Adultes, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Lengline
authors.affiliation: Unité Thérapie Cellulaire, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Larghero
authors.affiliation: Laboratoire D'immunologie Et Histocompatibilité, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Charron
authors.affiliation: Laboratoire D'immunologie Et Histocompatibilité, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Loiseau
authors.affiliation: Service D'hématologie Greffe, Hôpital Saint-Louis, AP-HP, Paris, France.|Université Paris Diderot Sorbonne Paris Cité, Paris, F-75475, France.|Inserm UMR1160 Et Centre D'investigation Clinique En Biotherapies (CICBT501), Institut Universitaire D'hématologie, Paris, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.affiliation: Unité Hématologie Adolescents Jeunes Adultes, Hôpital Saint-Louis, AP-HP, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Dhédin
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D036101:Cord Blood Stem Cell Transplantation; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality*; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D061349:Unrelated Donors