Synapse - Graft-versus-host disease after double-unit cord blood transplantation has unique features and an association with engrafting unit-to-recipient HLA match

Graft-versus-host disease after double-unit cord blood transplantation has unique features and an association with engrafting unit-to-recipient HLA match Journal Article

Authors:	Ponce, D. M.; Gonzales, A.; Lubin, M.; Castro-Malaspina, H.; Giralt, S.; Goldberg, J. D.; Hanash, A. M.; Jakubowski, A.; Jenq, R.; Papadopoulos, E. B.; Perales, M. A.; van den Brink, M. R. M.; Young, J. W.; Boulad, F.; O'Reilly, R. J.; Prockop, S.; Small, T. N.; Scaradavou, A.; Kernan, N. A.; Stevens, C. E.; Barker, J. N.
Article Title:	Graft-versus-host disease after double-unit cord blood transplantation has unique features and an association with engrafting unit-to-recipient HLA match
Abstract:	Manifestations of and risk factors for graft-versus-host disease (GVHD) after double-unit cord blood transplantation (DCBT) are not firmly established. We evaluated 115 DCBT recipients (median age, 37 years) who underwent transplantation for hematologic malignancies with myeloablative or nonmyeloablative conditioning and calcineurin inhibitor/mycophenolate mofetil immunosuppression. Incidence of day 180 grades II to IV and III to IV acute GVHD (aGVHD) were 53% (95% confidence interval, 44 to 62) and 23% (95% confidence interval, 15 to 31), respectively, with a median onset of 40 days (range, 14 to 169). Eighty percent of patients with grades II to IV aGVHD had gut involvement, and 79% and 85% had day 28 treatment responses to systemic corticosteroids or budesonide, respectively. Of 89 engrafted patients cancer-free at day 100, 54% subsequently had active GVHD, with 79% of those affected having persistent or recurrent aGVHD or overlap syndrome. Late GVHD in the form of classic chronic GVHD was uncommon. Notably, grades III to IV aGVHD incidence was lower if the engrafting unit human leukocyte antigen (HLA)-A, -B, -DRB1 allele match was >4/6 to the recipient (hazard ratio, 0.385; P = .031), whereas engrafting unit infused nucleated cell dose and unit-to-unit HLA match were not significant. GVHD after DCBT was common in our study, predominantly affected the gut, and had a high therapy response, and late GVHD frequently had acute features. Our findings support the consideration of HLA- A,-B,-DRB1 allele donor-recipient (but not unit-unit) HLA match in unit selection, a practice change in the field. Moreover, new prophylaxis strategies that target the gastrointestinal tract are needed. © 2013 American Society for Blood and Marrow Transplantation.
Keywords:	graft-versus-host disease; cord blood transplantation; hla match
Journal Title:	Biology of Blood and Marrow Transplantation
Volume:	19
Issue:	6
ISSN:	1083-8791
Publisher:	Elsevier Inc.
Date Published:	2013-06-01
Start Page:	904
End Page:	911
Language:	English
DOI:	10.1016/j.bbmt.2013.02.008
PROVIDER:	scopus
PUBMED:	23416854
PMCID:	PMC3673765
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84877910561&partnerID=40&md5=0c84173e343dd1e5b77e60502369de70
Notes:	--- - Cited By (since 1996):1 - "Export Date: 3 June 2013" - "CODEN: BBMTF" - "Source: Scopus"