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Unrelated cord blood transplantation vs related transplantation with HLA 1-antigen mismatch in the graft-versus-host direction

2012; Springer Nature; Volume: 27; Issue: 2 Linguagem: Inglês

10.1038/leu.2012.203

1476-5551

Junya Kanda, Tatsuo Ichinohe, Shingo Kato, Naoyuki Uchida, Seitaro Terakura, Takahiro Fukuda, Michihiro Hidaka, Yasunori Ueda, Tadakazu Kondo, Satoshi Taniguchi, Satoshi Takahashi, Tokiko Nagamura‐Inoue, Junji Tanaka, Yoshiko Atsuta, Koichi Miyamura, Yoshinobu Kanda,

Immune Cell Function and Interaction

Little information is available regarding whether an unrelated cord blood (UCB) unit or a related donor with a 1-antigen mismatch at the HLA-A, HLA-B or HLA-DR locus in the graft-versus-host direction (RD/1AG-MM-GVH) should be selected as an alternative donor for patients without an HLA-matched related/unrelated donor. Therefore, we conducted a retrospective study using national registry data on patients with leukemia or myelodysplastic syndrome who received transplantation using a single UCB (n=2288) unit or an RD/1AG-MM-GVH (n=525). We found that the survival rate in the UCB group was comparable to that in the RD/1AG-MM-GVH group, although the RD/1AG-MM-GVH group with an HLA-B mismatch showed significantly higher overall and non-relapse mortality. Neutrophil and platelet engraftment were significantly faster, whereas the incidence of acute or chronic graft-versus-host disease (GVHD) was significantly higher in the RD/1AG-MM-GVH group. The incidence of acute or chronic GVHD in the RD/1AG-MM-GVH group with in vivo T-cell depletion was comparable to that in the UCB group, which translated into a trend toward better overall survival, regardless of the presence of an HLA-B mismatch. In conclusion, UCB and RD/1AG-MM-GVH are comparable for use as an alternative donor, except for RD/1AG-MM-GVH involving an HLA-B mismatch.