Graft-versus-Host Disease after Double-Unit Cord Blood Transplantation Has Unique Features and an Association with Engrafting Unit-to-Recipient HLA Match

Autor: Doris M. Ponce, Marissa Lubin, M.R.M. van den Brink, Trudy N. Small, Esperanza B. Papadopoulos, Sergio Giralt, Alan M. Hanash, R.J. O'Reilly, Robert R. Jenq, Susan E. Prockop, Anne Marie Gonzales, Juliet N. Barker, Jenna D. Goldberg, Cladd E. Stevens, Ann A. Jakubowski, Nancy A. Kernan, Farid Boulad, Miguel-Angel Perales, Andromachi Scaradavou, James W. Young, Hugo Castro-Malaspina
Rok vydání: 2013
Předmět:
Male
Transplantation Conditioning
Cord blood transplantation
medicine.medical_treatment
Graft vs Host Disease
Severity of Illness Index
Graft-versus-host disease
Gastroenterology
Adrenal Cortex Hormones
HLA Antigens
immune system diseases
Enzyme Inhibitors
Budesonide
Child
Calcineurin
Histocompatibility Testing
Hazard ratio
Immunosuppression
Hematology
Middle Aged
Treatment Outcome
surgical procedures
operative
Child
Preschool
Hematologic Neoplasms
Female
Cord Blood Stem Cell Transplantation
medicine.drug
Adult
medicine.medical_specialty
Adolescent
Calcineurin Inhibitors
Human leukocyte antigen
Article
Mycophenolic acid
Internal medicine
medicine
Transplantation
Homologous
Humans
Aged
Transplantation
business.industry
Infant
Mycophenolic Acid
Myeloablative Agonists
medicine.disease
Survival Analysis
Gastrointestinal Tract
HLA match
Immunology
business
Zdroj: Biology of Blood and Marrow Transplantation. 19:904-911
ISSN: 1083-8791
DOI: 10.1016/j.bbmt.2013.02.008
Popis: 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.
Databáze: OpenAIRE
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