Cord blood unit dominance analysis and effect of winning unit on outcomes after double-unit umbilical cord blood transplantation in adults with acute leukemia: a retrospective study on behalf of Eurocord, the Cord Blood Committee of Cellular Therapy and Immunobilogy Working Party, and Acute Leukemia Working Party of the European group for blood and marrow transplantation

Research output: Contribution to journalArticle

Authors

  • Karina Tozatto-maio
  • Federica Giannotti
  • Myriam Labopin
  • Annalisa Ruggeri
  • Fernanda Volt
  • Annalisa Paviglianiti
  • Chantal Kenzey
  • Hiromi Hayashi
  • Jan Cornelissen
  • Mauricette Michallet
  • Dimitrios Karakasis
  • Eric Deconinck
  • Pierre-simon Rohrlich
  • Regis Peffault De La Tour
  • Didier Blaise
  • Eefke Petersen
  • Maud D'aveni
  • Henrik Sengeloev
  • Thierry Lamy
  • Nigel H. Russell
  • Edouard Forcade
  • Arnon Nagler
  • Eliane Gluckman
  • Vanderson Rocha

Colleges, School and Institutes

Abstract

Usually, after double umbilical cord blood transplantation (DUCBT), only 1 of the transplanted units persists in the long term. The characteristics of the winning cord blood unit (W-CBU) that determine unit dominance and how they influence the outcomes of DUCBT remain unclear. We retrospectively analyzed 347 patients with acute leukemia transplanted with a DUCBT (694 CBU) from 2005 to 2013 who had documented neutrophil engraftment and a W-CBU identified by chimerism analysis, to identify unit characteristics impacting on dominance. Median age at DUCBT was 40 years and median follow-up was 35 months. Among W-CBUs, 41% were ≥5/6 HLA matched to the recipient and 59% were ≤4/6. Multivariate analysis indicated that ≤4/6 HLA-matched W-CBUs led to lower leukemia-free survival (44% versus 56%; hazard ratio [HR], 1.5; P = .032) and overall survival (49% versus 62%; HR, 1.5; P = .028), increased nonrelapse mortality (26% versus 18%; HR, 1.9; P = .027), and acute graft-versus-host disease (46% versus 35%; HR, 1.7; P = .013). We were unable to predict unit dominance, but we demonstrated that outcomes were strongly influenced by the degree of HLA mismatch between W-CBU and recipient. Therefore, selection of both units with the lower number of HLA mismatches with the recipient is indicated.

Details

Original languageEnglish
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Early online date1 Mar 2018
Publication statusE-pub ahead of print - 1 Mar 2018

Keywords

  • Double cord blood transplantation, Winning cord blood unit, Unit dominance, Acute leukemia, HLA