Effect of HLA-matching recipients to donor noninherited maternal antigens on outcomes after mismatched umbilical cord blood transplantation for hematologic malignancy.
Abstract
Transplantation-related mortality (TRM) is high after HLA-mismatched umbilical cord
blood (UCB) transplantation (UCBT). In utero, exposure to noninherited maternal antigen
(NIMA) is recognized by the fetus, which induces T regulator cells to that haplotype.
It is plausible that UCBTs in which recipients are matched to donor NIMAs may alleviate
some of the excess mortality associated with this treatment. To explore this concept,
we used marginal matched-pair Cox regression analysis to compare outcomes in 48 NIMA-matched
UCBTs (ie, the NIMA of the donor UCB unit matched to the patient) and in 116 non-NIMA-matched
UCBTs. All patients had a hematologic malignancy and received a single UCB unit. Cases
and controls were matched on age, disease, disease status, transplantation-conditioning
regimen, HLA match, and infused cell dose. TRM was lower after NIMA-matched UCBTs
compared with NIMA-mismatched UCBTs (relative risk, 0.48; P = .05; 18% versus 32%
at 5 years posttransplantation). Consequently, overall survival was higher after NIMA-matched
UCBT. The 5-year probability of overall survival was 55% after NIMA-matched UCBTs
versus 38% after NIMA-mismatched UCBTs (P = .04). When faced with the choice of multiple
HLA-mismatched UCB units containing adequate cell doses, selecting an NIMA-matched
UCB unit may improve survival after mismatched UCBT.
Type
Journal articleSubject
Eurocord-European Blood and Marrow Transplant Group and the Center for International
Blood and Marrow Transplant ResearchFetal Blood
Humans
Leukemia
Lymphoma
HLA Antigens
Treatment Outcome
Cord Blood Stem Cell Transplantation
Survival Rate
Adolescent
Tissue Donors
Female
Male
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https://hdl.handle.net/10161/24665Published Version (Please cite this version)
10.1016/j.bbmt.2012.07.010Publication Info
Rocha, Vanderson; Spellman, Stephen; Zhang, Mei-Jie; Ruggeri, Annalisa; Purtill, Duncan;
Brady, Colleen; ... Eurocord-European Blood and Marrow Transplant Group and the Center
for International Blood and Marrow Transplant Research (2012). Effect of HLA-matching recipients to donor noninherited maternal antigens on outcomes
after mismatched umbilical cord blood transplantation for hematologic malignancy.
Biology of blood and marrow transplantation : journal of the American Society for
Blood and Marrow Transplantation, 18(12). pp. 1890-1896. 10.1016/j.bbmt.2012.07.010. Retrieved from https://hdl.handle.net/10161/24665.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Joanne Kurtzberg
Jerome S. Harris Distinguished Professor of Pediatrics
Dr. Kurtzberg is an internationally renowned expert in pediatric hematology/oncology,
pediatric blood and marrow transplantation, umbilical cord blood banking and transplantation,
and novel applications of cord blood and birthing tissues in the emerging fields of
cellular therapies and regenerative medicine. Dr. Kurtzberg serves as the Director
of the Marcus Center for Cellular Cures (MC3), Director of the Pediatric Transplant
and Cellular Therapy Program, Director of the Carolina
Vinod K. Prasad
Consulting Professor in the Department of Pediatrics
1. Expanding the role of umbilical cord blood transplants for inherited metabolic
disorders. 2. Impact of histocompatibility and other determinants of alloreactivity
on clinical outcomes of unrelated cord blood transplants. 3. Studies to analyse the
impact of Killer Immunoglobulin receptors on the outcomes of hematopoietic stem cell
transplantation utilizing haploidentical, CD34 selected, familial grafts. 4. Propective
longitudinal study of serial monitoring of adenovirus in
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