Combined effect of total nucleated cell dose and HLA match on transplantation outcome in 1061 cord blood recipients with hematologic malignancies Journal Article


Authors: Barker, J. N.; Scaradavou, A.; Stevens, C. E.
Article Title: Combined effect of total nucleated cell dose and HLA match on transplantation outcome in 1061 cord blood recipients with hematologic malignancies
Abstract: Both total nucleated cell (TNC) dose and human leukocyte antigen (HLA)-match affect the outcome of cord blood (CB) transplantation. However, how to prioritize these characteristics in unit selection is not established. Therefore, we analyzed the outcomes of 1061 patients who received single-unit myeloablative CB transplantation for leukemia or myelodysplasia. TNC dose and HLA-match each affected survival via their effect on transplant-related mortality (TRM); neither was associated with relapse. Therefore,TRM was the focus of multivariate analyses combining dose and HLA-match. Compared with our 1 HLA-mismatch (MM) reference group with TNC 2.5 to 4.9 × 10 7/kg, recipients of 0 MM units had the lowest TRM regardless of dose (relative risk [RR] = 0.4, P = .019). TRM for recipients of 1- or 2-MM units with TNC 5.0 × 107/kg or greater was similar to the reference group (RR = 0.8, P = .391 and RR = 1.0, P = .847) despite their greater dose. Recipients of 2 MM units with TNC 2.5 to 4.9 × 107/kg had a greater TRM (RR = 1.5, P = .014), and those with 1 or 2 MM and TNC less than 2.5 × 107/kg or 3 MM did substantially worse. These findings support new unit selection criteria that take into account both TNC dose and HLA-match and have important implications for the size of the global CB inventory needed to find an optimum CB graft. © 2010 by The American Society of Hematology.
Keywords: survival; adolescent; adult; child; controlled study; preschool child; school child; treatment outcome; child, preschool; middle aged; survival analysis; graft infection; young adult; major clinical study; mortality; methotrexate; outcome assessment; cytology; multiple myeloma; relapse; chronic myeloid leukemia; acute lymphoblastic leukemia; cause of death; blood; immunology; cord blood stem cell transplantation; graft failure; hla matching; myeloablative conditioning; myelodysplastic syndrome; fetal blood; blood disease; fetus blood; hematologic neoplasms; neutrophil; infant; infant, newborn; newborn; graft versus host reaction; thrombocyte count; umbilical cord blood; neutrophils; blood cell count; leukocyte count; graft survival; corticosteroid; cyclosporin a; graft vs host disease; platelet count; myeloid leukemia; histocompatibility testing; histocompatibility test
Journal Title: Blood
Volume: 115
Issue: 4
ISSN: 0006-4971
Publisher: American Society of Hematology  
Date Published: 2010-03-04
Start Page: 1843
End Page: 1849
Language: English
DOI: 10.1182/blood-2009-07-231068
PUBMED: 20029048
PROVIDER: scopus
PMCID: PMC5003507
DOI/URL:
Notes: --- - "Cited By (since 1996): 12" - "Export Date: 20 April 2011" - "CODEN: BLOOA" - "Source: Scopus"
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  1. Juliet N Barker
    296 Barker