TY - JOUR
T1 - Cord blood unit dominance analysis and effect of winning unit on outcomes after double-unit umbilical cord blood transplantation in adults with acute leukemia
T2 - 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
AU - Tozatto-maio, Karina
AU - Giannotti, Federica
AU - Labopin, Myriam
AU - Ruggeri, Annalisa
AU - Volt, Fernanda
AU - Paviglianiti, Annalisa
AU - Kenzey, Chantal
AU - Hayashi, Hiromi
AU - Cornelissen, Jan
AU - Michallet, Mauricette
AU - Karakasis, Dimitrios
AU - Deconinck, Eric
AU - Rohrlich, Pierre-simon
AU - De La Tour, Regis Peffault
AU - Blaise, Didier
AU - Petersen, Eefke
AU - D'aveni, Maud
AU - Sengeloev, Henrik
AU - Lamy, Thierry
AU - Russell, Nigel H.
AU - Forcade, Edouard
AU - Craddock, Charles F.
AU - Nagler, Arnon
AU - Gluckman, Eliane
AU - Rocha, Vanderson
PY - 2018/3/1
Y1 - 2018/3/1
N2 - 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.
AB - 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.
KW - Double cord blood transplantation
KW - Winning cord blood unit
KW - Unit dominance
KW - Acute leukemia
KW - HLA
U2 - 10.1016/j.bbmt.2018.02.014
DO - 10.1016/j.bbmt.2018.02.014
M3 - Article
SN - 1083-8791
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
ER -