title: The effect of inter-unit HLA matching in double umbilical cord blood transplantation for acute leukemia.
abstract: The effects of inter-unit HLA-match on early outcomes with regards to double cord blood transplantation have not been established. Therefore, we studied the effect of inter-unit HLA-mismatching on the outcomes of 449 patients with acute leukemia after double cord blood transplantation. Patients were divided into two groups: one group that included transplantations with inter-unit mismatch at 2 or less HLA-loci (n=381) and the other group with inter-unit mismatch at 3 or 4 HLA-loci (n=68). HLA-match considered low resolution matching at HLA-A and -B loci and allele-level at HLA-DRB1, the accepted standard for selecting units for double cord blood transplants. Patients', disease, and transplant characteristics were similar in the two groups. We observed no effect of the degree of inter-unit HLA-mismatch on neutrophil (Hazard Ratio 1.27,P=0.11) or platelet (Hazard Ratio 0.1.13,P=0.42) recovery, acute graft-versus-host disease (Hazard Ratio 1.17,P=0.36), treatment-related mortality (Hazard Ratio 0.92,P=0.75), relapse (Hazard Ratio 1.18,P=0.49), treatment failure (Hazard Ratio 0.99,P=0.98), or overall survival (Hazard Ratio 0.98,P=0.91). There were no differences in the proportion of transplants with engraftment of both units by three months (5% after transplantation of units with inter-unit mismatch at ≤2 HLA-loci and 4% after transplantation of units with inter-unit mismatch at 3 or 4 HLA-loci). Our observations support the elimination of inter-unit HLA-mismatch criterion when selecting cord blood units in favor of optimizing selection based on individual unit characteristics.
authors.affiliation: University of Minnesota Medical Center, Minneapolis, MN, USA.
authors.forename: Claudio
authors.initials: C
authors.lastname: Brunstein
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.|Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.affiliation: Adult Bone Marrow Transplant Services, Department of Medicine, Memorial Sloan-Kettering Cancer Center, and Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Juliet
authors.initials: J
authors.lastname: Barker
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: St Martin
authors.affiliation: Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA.
authors.forename: Asad
authors.initials: A
authors.lastname: Bashey
authors.affiliation: Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Marcos
authors.initials: M
authors.lastname: de Lima
authors.affiliation: National Marrow Donor Program/Be the Match, Minneapolis, MN, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Dehn
authors.affiliation: Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors.forename: Peiman
authors.initials: P
authors.lastname: Hematti
authors.affiliation: Adult Bone Marrow Transplant Services, Department of Medicine, Memorial Sloan-Kettering Cancer Center, and Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Perales
authors.affiliation: Churchill Hospital, Oxford, UK.
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.affiliation: UCLA Center for Health Sciences, Los Angeles, CA, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Territo
authors.affiliation: University of Minnesota Medical Center, Minneapolis, MN, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Weisdorf
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA meapen@mcw.edu.
authors.forename: Mary
authors.initials: M
authors.lastname: Eapen
mesh_terms: D000208:Acute Disease; D000328:Adult; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis; D015234:HLA-A Antigens / Q000032:analysis / Q000235:genetics; D015235:HLA-B Antigens / Q000032:analysis / Q000235:genetics; D059811:HLA-DRB1 Chains / Q000032:analysis / Q000235:genetics; D006650:Histocompatibility Testing; D006801:Humans; D053208:Kaplan-Meier Estimate; D007951:Leukemia, Myeloid / Q000628:therapy*; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D016016:Proportional Hazards Models
chemical_list: D015234:HLA-A Antigens; D015235:HLA-B Antigens; D059811:HLA-DRB1 Chains