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Transfusion. 2009 May;49(5):995-1002. doi: 10.1111/j.1537-2995.2008.02077.x. Epub 2009 Jan 21.

High-resolution HLA matching in double-umbilical-cord-blood reduced-intensity transplantation in adults.

Author information

  • 1Puget Sound Blood Center, Seattle, Washington 98104, USA. meghand@psbc.org

Abstract

BACKGROUND:

Double-cord-blood transplantation (DCBT) offers an option for patients receiving reduced-intensity transplants. These unique transplants have two donors, both of whom are usually HLA mismatched at one to two loci.

STUDY DESIGN AND METHODS:

Fifty-three patients were recipients of a reduced-intensity DCBT. Cords were at least 4/6 allele-level HLA-A, -B, and -DR match with the patient and each other with a minimum combined cell dose of more than 3.7 x 10(7) total nucleated cells per kg. Twenty-one patients received cyclosporine/mycophenolate mofetil and 32 patients received sirolimus/tacrolimus (SIR/TAC) for graft-versus-host disease prophylaxis. The effect of allele level HLA typing on clinical endpoints of overall survival (OS), disease-free survival (DFS), engraftment, and acute graft-versus-host disease (aGVHD) were assessed.

RESULTS:

Neutrophil (p = 0.001) engraftment and platelet engraftment (p = 0.027) were significantly faster in patients who have closer Class I (HLA-A, -B, -C) matching. Neutrophil engraftment was faster in patients who had closer HLA-B matching to their combined cords (p = 0.007). There was a low incidence of aGVHD overall, especially in the SIR/TAC group. Class I HLA matching had no effect on aGVHD. HLA-DR and -DQ had no effect on engraftment or aGVHD.

CONCLUSION:

Class I allele matching, and HLA-B matching specifically, were associated with faster neutrophil engraftment. High-resolution HLA matching did not affect OS or DFS.

PMID:
19159415
PMCID:
PMC2763583
DOI:
10.1111/j.1537-2995.2008.02077.x
[PubMed - indexed for MEDLINE]
Free PMC Article
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