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Biol Blood Marrow Transplant. 2018 Aug;24(8):1657-1663. doi: 10.1016/j.bbmt.2018.02.014. Epub 2018 Mar 1.

Cord Blood Unit Dominance Analysis and Effect of the 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, Immunobiology Working Party, and the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation.

Author information

1
Eurocord, Hôpital Saint Louis, Université Paris-Diderot, Paris, France; Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
2
Eurocord, Hôpital Saint Louis, Université Paris-Diderot, Paris, France; Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France; INSERM, URM_S 938, Université Pierre et Marie Curie, Paris, France.
3
Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France; INSERM, URM_S 938, Université Pierre et Marie Curie, Paris, France.
4
Eurocord, Hôpital Saint Louis, Université Paris-Diderot, Paris, France; Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France; Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.
5
Eurocord, Hôpital Saint Louis, Université Paris-Diderot, Paris, France.
6
Department of Hematology, Erasmus MC-Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands.
7
Hematology Department, Center Léon Berard, Lyon, France.
8
Department of Hematology and Lymphomas, Evangelismos Hospital, Athens, Greece.
9
Department of Hematology, CHU Jean Minjoz, Besançon, France.
10
Hematologie Clinique, CHU-Hôpital de l'ARCHET I, Nice, France.
11
BMT unit, Saint Louis Hospital, Paris, France.
12
Department of Hematology, Institut Paoli Calmettes, Marseille, France.
13
Department of Hematology, Cancer Center, University Medical Center, Utrecht, The Netherlands.
14
CHU et INSERM 954, Nancy Université, Vandœuvre-lès-Nancy, France.
15
BMT Unit Dept. of Hematology, Rigshospitalet, Copenhagen, Denmark.
16
Hematology Department, Rennes University Hospital, Rennes, France.
17
Department of Hematology, Nottingham University Hospital, Nottingham, United Kingdom.
18
Service d'Hématologie, CHU Bordeaux, Pessac, France.
19
Centre for Clinical Haematology, University Hospital Birmingham, Birmingham, United Kingdom.
20
Hematology Division, BMT and Cord Blood Bank, Chaim Sheba Medical Center, Tel-Aviv University, Ramat-Gan, Israel.
21
Eurocord, Hôpital Saint Louis, Université Paris-Diderot, Paris, France; Department of Hematology, Churchill Hospital, NHS BT, Oxford University, Oxford, United Kingdom; Serviço de Hematologia, Hemoterapia e Terapia Celular, Universidade de São Paulo, SP, Brazil. Electronic address: rocha.vanderson@hotmail.fr.

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.

KEYWORDS:

Acute leukemia; Double cord blood transplantation; HLA; Unit dominance; Winning cord blood unit

PMID:
29477777
DOI:
10.1016/j.bbmt.2018.02.014

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