Effect of HLA-matching recipients to donor noninherited maternal antigens on outcomes after mismatched umbilical cord blood transplantation for hematologic malignancy - PubMed (original) (raw)

. 2012 Dec;18(12):1890-6.

doi: 10.1016/j.bbmt.2012.07.010. Epub 2012 Jul 17.

Stephen Spellman, Mei-Jie Zhang, Annalisa Ruggeri, Duncan Purtill, Colleen Brady, Lee Ann Baxter-Lowe, Etienne Baudoux, Paola Bergamaschi, Robert Chow, Brian Freed, Gesine Koegler, Joanne Kurtzberg, Jerome Larghero, Lucilla Lecchi, Arnon Nagler, Cristina Navarrette, Vinod Prasad, Fabienne Pouthier, Thomas Price, Voravit Ratanatharathorn, Jon J van Rood, Mary M Horowitz, Eliane Gluckman, Mary Eapen; Eurocord-European Blood and Marrow Transplant Group and the Center for International Blood and Marrow Transplant Research

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Effect of HLA-matching recipients to donor noninherited maternal antigens on outcomes after mismatched umbilical cord blood transplantation for hematologic malignancy

Vanderson Rocha et al. Biol Blood Marrow Transplant. 2012 Dec.

Abstract

Transplantation-related mortality (TRM) is high after HLA-mismatched umbilical cord blood (UCB) transplantation (UCBT). In utero, exposure to noninherited maternal antigen (NIMA) is recognized by the fetus, which induces T regulator cells to that haplotype. It is plausible that UCBTs in which recipients are matched to donor NIMAs may alleviate some of the excess mortality associated with this treatment. To explore this concept, we used marginal matched-pair Cox regression analysis to compare outcomes in 48 NIMA-matched UCBTs (ie, the NIMA of the donor UCB unit matched to the patient) and in 116 non-NIMA-matched UCBTs. All patients had a hematologic malignancy and received a single UCB unit. Cases and controls were matched on age, disease, disease status, transplantation-conditioning regimen, HLA match, and infused cell dose. TRM was lower after NIMA-matched UCBTs compared with NIMA-mismatched UCBTs (relative risk, 0.48; P = .05; 18% versus 32% at 5 years posttransplantation). Consequently, overall survival was higher after NIMA-matched UCBT. The 5-year probability of overall survival was 55% after NIMA-matched UCBTs versus 38% after NIMA-mismatched UCBTs (P = .04). When faced with the choice of multiple HLA-mismatched UCB units containing adequate cell doses, selecting an NIMA-matched UCB unit may improve survival after mismatched UCBT.

Copyright © 2012. Published by Elsevier Inc.

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Figures

Figure 1

Figure 1

(A) The 5-year probabilities of transplant-related mortality were 18% (95% CI, 8%–29%) after NIMA-matched transplantation and 32% (95% CI, 23%–41%) after NIMA-mismatched transplantation. (B) The 5-year probabilities of overall survival were 55% (95% CI, 40%–69%) after NIMA-matched transplantation and 38% (95% CI, 29%–48%) after NIMA-mismatched transplantation.

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References

    1. Eapen M, Rubinstein P, Zhang M-J, et al. Outcomes of transplantation of unrelated donor umbilical cord blood and bone marrow in children with acute leukemia: a comparison study. Lancet. 2007;369:1947–1954. -PubMed
    1. Eapen M, Rocha V, Sanz G, et al. Effect of graft source on unrelated donor hematopoietic stem-cell transplantation in adults with acute leukemia: a retrospective analysis. Lancet Oncol. 2010;11:653–660. -PMC -PubMed
    1. Gluckman E, Ruggeri A, Volt F, et al. Milestones in umbilical cord blood transplantation. Br J Haematol. 2011;154:441–447. -PubMed
    1. Delaney C, Gutman JA, Appelbaum FR. Cord blood transplantation for haematological malignancies: conditioning regimens, double cord blood transplant and infectious complications. Br J Haematol. 2009;147:207–216. -PubMed
    1. Brunstein CG, Barker JN, Weisdorf DJ, et al. Umbilical cord blood transplantation after non-myeloablative conditioning regimen: impact on transplantation outcomes in 110 adults with hematologic diseases. Blood. 2007;110:3064–3070. -PMC -PubMed

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