Haematologica (May 2013)

Different effects of HLA disparity on transplant outcomes after single-unit cord blood transplantation between pediatric and adult patients with leukemia

  • Yoshiko Atsuta,
  • Junya Kanda,
  • Minoko Takanashi,
  • Yasuo Morishima,
  • Shuichi Taniguchi,
  • Satoshi Takahashi,
  • Hiroyasu Ogawa,
  • Kazuteru Ohashi,
  • Yuju Ohno,
  • Yasushi Onishi,
  • Nobuyuki Aotsuka,
  • Tokiko Nagamura-Inoue,
  • Koji Kato,
  • Yoshinobu Kanda

DOI
https://doi.org/10.3324/haematol.2012.076042
Journal volume & issue
Vol. 98, no. 5

Abstract

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Recent advances in unrelated cord blood transplantation have increased chances and options available in allogeneic stem cell transplantation. The effect of HLA disparity on outcomes after cord blood transplantation was studied recently in mainly pediatric populations. Results showed that HLA matching in combination with total nucleated cell dose positively affects survival. The effect of HLA disparity after single-unit cord blood transplantation may be different in adults because their total nucleated cell dose is much lower compared to pediatric patients. We investigated the effect of HLA disparity on the outcome of single-unit unrelated cord blood transplantation separately in 498 children aged 15 years or under (HLA-A, HLA-B low-resolution, and HLA-DRB1 high-resolution matched [6/6], n=82, and one locus- [5/6], n=222, two loci- [4/6], n=158, three loci- [3/6] mismatched, n=36) and 1,880 adults (6/6, n=71; 5/6, n=309; 4/6, n=1,025; 3/6, n=475) with leukemia. With adjusted analyses, in children, 4/6 showed significantly increased risks of overall mortality (relative risk [RR]=1.61, P=0.042) and transplant-related mortality (RR=3.55, P=0.005) compared to 6/6. The risk of grade 2 to 4 acute GVHD was increased in 5/6 (RR=2.13, P=0.004) and 4/6 (RR=2.65, P