The effect of inter-unit HLA matching in double umbilical cord blood transplantation for acute leukemia

Claudio Brunstein; Mei Jie Zhang; Juliet Barker; Andrew St. Martin; Asad Bashey; Marcos De Lima; Jason Dehn; Peiman Hematti; Miguel Angel Perales; Vanderson Rocha; Mary Territo; Daniel Weisdorf; Mary Eapen

doi:10.3324/haematol.2016.158584

The effect of inter-unit HLA matching in double umbilical cord blood transplantation for acute leukemia

Claudio Brunstein, Mei Jie Zhang, Juliet Barker, Andrew St. Martin, Asad Bashey, Marcos De Lima, Jason Dehn, Peiman Hematti, Miguel Angel Perales, Vanderson Rocha, Mary Territo, Daniel Weisdorf, Mary Eapen

Medicine - Hematology, Oncology, Transplant

Research output: Contribution to journal › Article › peer-review

12 Scopus citations

Abstract

The effects of inter-unit HLA-match on early outcomes with regards to double cord blood transplantation have not been established. Therefore, we studied the effect of inter-unit HLA-mismatching on the outcomes of 449 patients with acute leukemia after double cord blood transplantation. Patients were divided into two groups: one group that included transplantations with inter-unit mismatch at 2 or less HLA-loci (n=381) and the other group with inter-unit mismatch at 3 or 4 HLA-loci (n=68). HLA-match considered low resolution matching at HLA-A and -B loci and allele-level at HLA-DRB1, the accepted standard for selecting units for double cord blood transplants. Patients’, disease, and transplant characteristics were similar in the two groups. We observed no effect of the degree of inter-unit HLA-mismatch on neutrophil (Hazard Ratio 1.27, P=0.11) or platelet (Hazard Ratio 0.1.13, P=0.42) recovery, acute graft-versus-host disease (Hazard Ratio 1.17, P=0.36), treatment-related mortality (Hazard Ratio 0.92, P=0.75), relapse (Hazard Ratio 1.18, P=0.49), treatment failure (Hazard Ratio 0.99, P=0.98), or overall survival (Hazard Ratio 0.98, P=0.91). There were no differences in the proportion of transplants with engraftment of both units by three months (5% after transplantation of units with inter-unit mismatch at ≤2 HLA-loci and 4% after transplantation of units with inter-unit mismatch at 3 or 4 HLA-loci). Our observations support the elimination of inter-unit HLA-mismatch criterion when selecting cord blood units in favor of optimizing selection based on individual unit characteristics.

Original language	English (US)
Pages (from-to)	941-947
Number of pages	7
Journal	Haematologica
Volume	102
Issue number	5
DOIs	https://doi.org/10.3324/haematol.2016.158584
State	Published - Apr 30 2017

Bibliographical note

Funding Information:
The CIBMTR is supported by Public Health Service Grant U24-CA076518 from the National Cancer Institute, the National Heart, Lung and Blood Institute and the National Institute of Allergy and Infectious Diseases, a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS) and grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research.

Publisher Copyright:
© 2017 Ferrata Storti Foundation.

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10.3324/haematol.2016.158584

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477613

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@article{074d1cb797f2451e98db647ef00336cb,

title = "The effect of inter-unit HLA matching in double umbilical cord blood transplantation for acute leukemia",

abstract = "The effects of inter-unit HLA-match on early outcomes with regards to double cord blood transplantation have not been established. Therefore, we studied the effect of inter-unit HLA-mismatching on the outcomes of 449 patients with acute leukemia after double cord blood transplantation. Patients were divided into two groups: one group that included transplantations with inter-unit mismatch at 2 or less HLA-loci (n=381) and the other group with inter-unit mismatch at 3 or 4 HLA-loci (n=68). HLA-match considered low resolution matching at HLA-A and -B loci and allele-level at HLA-DRB1, the accepted standard for selecting units for double cord blood transplants. Patients{\textquoteright}, disease, and transplant characteristics were similar in the two groups. We observed no effect of the degree of inter-unit HLA-mismatch on neutrophil (Hazard Ratio 1.27, P=0.11) or platelet (Hazard Ratio 0.1.13, P=0.42) recovery, acute graft-versus-host disease (Hazard Ratio 1.17, P=0.36), treatment-related mortality (Hazard Ratio 0.92, P=0.75), relapse (Hazard Ratio 1.18, P=0.49), treatment failure (Hazard Ratio 0.99, P=0.98), or overall survival (Hazard Ratio 0.98, P=0.91). There were no differences in the proportion of transplants with engraftment of both units by three months (5% after transplantation of units with inter-unit mismatch at ≤2 HLA-loci and 4% after transplantation of units with inter-unit mismatch at 3 or 4 HLA-loci). Our observations support the elimination of inter-unit HLA-mismatch criterion when selecting cord blood units in favor of optimizing selection based on individual unit characteristics.",

author = "Claudio Brunstein and Zhang, {Mei Jie} and Juliet Barker and {St. Martin}, Andrew and Asad Bashey and {De Lima}, Marcos and Jason Dehn and Peiman Hematti and Perales, {Miguel Angel} and Vanderson Rocha and Mary Territo and Daniel Weisdorf and Mary Eapen",

note = "Funding Information: The CIBMTR is supported by Public Health Service Grant U24-CA076518 from the National Cancer Institute, the National Heart, Lung and Blood Institute and the National Institute of Allergy and Infectious Diseases, a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS) and grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research. Publisher Copyright: {\textcopyright} 2017 Ferrata Storti Foundation.",

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AU - Brunstein, Claudio

AU - Zhang, Mei Jie

AU - Barker, Juliet

AU - St. Martin, Andrew

AU - Bashey, Asad

AU - De Lima, Marcos

AU - Dehn, Jason

AU - Hematti, Peiman

AU - Perales, Miguel Angel

AU - Rocha, Vanderson

AU - Territo, Mary

AU - Weisdorf, Daniel

AU - Eapen, Mary

N1 - Funding Information: The CIBMTR is supported by Public Health Service Grant U24-CA076518 from the National Cancer Institute, the National Heart, Lung and Blood Institute and the National Institute of Allergy and Infectious Diseases, a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS) and grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research. Publisher Copyright: © 2017 Ferrata Storti Foundation.

PY - 2017/4/30

Y1 - 2017/4/30

N2 - The effects of inter-unit HLA-match on early outcomes with regards to double cord blood transplantation have not been established. Therefore, we studied the effect of inter-unit HLA-mismatching on the outcomes of 449 patients with acute leukemia after double cord blood transplantation. Patients were divided into two groups: one group that included transplantations with inter-unit mismatch at 2 or less HLA-loci (n=381) and the other group with inter-unit mismatch at 3 or 4 HLA-loci (n=68). HLA-match considered low resolution matching at HLA-A and -B loci and allele-level at HLA-DRB1, the accepted standard for selecting units for double cord blood transplants. Patients’, disease, and transplant characteristics were similar in the two groups. We observed no effect of the degree of inter-unit HLA-mismatch on neutrophil (Hazard Ratio 1.27, P=0.11) or platelet (Hazard Ratio 0.1.13, P=0.42) recovery, acute graft-versus-host disease (Hazard Ratio 1.17, P=0.36), treatment-related mortality (Hazard Ratio 0.92, P=0.75), relapse (Hazard Ratio 1.18, P=0.49), treatment failure (Hazard Ratio 0.99, P=0.98), or overall survival (Hazard Ratio 0.98, P=0.91). There were no differences in the proportion of transplants with engraftment of both units by three months (5% after transplantation of units with inter-unit mismatch at ≤2 HLA-loci and 4% after transplantation of units with inter-unit mismatch at 3 or 4 HLA-loci). Our observations support the elimination of inter-unit HLA-mismatch criterion when selecting cord blood units in favor of optimizing selection based on individual unit characteristics.

AB - The effects of inter-unit HLA-match on early outcomes with regards to double cord blood transplantation have not been established. Therefore, we studied the effect of inter-unit HLA-mismatching on the outcomes of 449 patients with acute leukemia after double cord blood transplantation. Patients were divided into two groups: one group that included transplantations with inter-unit mismatch at 2 or less HLA-loci (n=381) and the other group with inter-unit mismatch at 3 or 4 HLA-loci (n=68). HLA-match considered low resolution matching at HLA-A and -B loci and allele-level at HLA-DRB1, the accepted standard for selecting units for double cord blood transplants. Patients’, disease, and transplant characteristics were similar in the two groups. We observed no effect of the degree of inter-unit HLA-mismatch on neutrophil (Hazard Ratio 1.27, P=0.11) or platelet (Hazard Ratio 0.1.13, P=0.42) recovery, acute graft-versus-host disease (Hazard Ratio 1.17, P=0.36), treatment-related mortality (Hazard Ratio 0.92, P=0.75), relapse (Hazard Ratio 1.18, P=0.49), treatment failure (Hazard Ratio 0.99, P=0.98), or overall survival (Hazard Ratio 0.98, P=0.91). There were no differences in the proportion of transplants with engraftment of both units by three months (5% after transplantation of units with inter-unit mismatch at ≤2 HLA-loci and 4% after transplantation of units with inter-unit mismatch at 3 or 4 HLA-loci). Our observations support the elimination of inter-unit HLA-mismatch criterion when selecting cord blood units in favor of optimizing selection based on individual unit characteristics.

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The effect of inter-unit HLA matching in double umbilical cord blood transplantation for acute leukemia

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