Impact of HLA disparity in the graft-versus-host direction on engraftment in adult patients receiving reduced-intensity cord blood transplantation

Abstract

Delayed engraftment or graft failure is one of the major complications after cord blood transplantation (CBT). To investigate factors impacting engraftment, we conducted a retrospective analysis of adult patients who underwent reducedintensity CBT at our institute, in which preparative regimens mainly consisted of fludarabine, melphalan, and total body irradiation with graft-versus-host (GVH) disease prophylaxis using single calcineurin inhibitors. Among 152 evaluable patients, the cumulative incidence of neutrophil engraftment was 89%. High total nucleated cell and CD34 ؉ cell dose were associated with the faster speed and higher probability of engraftment. In addition, the degree of human leukocyte antigen (HLA) mismatch in the GVH direction was inversely associated with engraftment kinetics, whereas no statistically significant association was observed with the degree of HLA mismatch in the hostversus-graft direction. Similarly, the number of HLA class I antigens mismatched in the GVH direction, but not in the hostversus-graft direction, showed a negative correlation with engraftment kinetics. HLA disparity did not have significant impact on the development of GVH disease or survival. This result indicates the significant role of HLA disparity in the GVH direction in the successful engraftment, raising the novel mechanism responsible for graft failure in

The impact of CD34+ cell dose on engraftment after SCTs: personalized estimates based on mathematical modeling

“…Up to now, several risk factors for delayed engraftment have been identified, including HHV6 infection, 44 gene polymorphisms, 45 splenomegaly 46,47 and others. 3,[44][45][46][47][48][49][50][51][52][53] The current results underline that further investigation of this topic Figure 4. Calibration of the model to different clinical scenarios: (a) autologous PBSC with and without post transplant cytokine administration; patient data taken from Lowenthal et al 27 (b) Allogeneic HLA-identical PBSC without post transplant cytokine administration; patient data taken from trials by Vigorito et al 30 and Bensinger et al 31 (c) Allogeneic HLA-identical PBSC with post transplant cytokine administration; patient data taken from different trials.…”

HLA mismatch direction in cord blood transplantation: impact on outcome and implications for cord blood unit selection

“…26,27 Another study in adult recipients of related, mismatched bone marrow reported increased graft failure with increasing number of class I rejection mismatches and increased risk of acute GVHD with increasing number of class II GVH mismatches. 28 Data from these studies, however, are somewhat ambiguous.…”

Impact of sex incompatibility on the outcome of single-unit cord blood transplantation for adult patients with hematological malignancies

“…[9][10][11][12][13] As the majority of patients receive an HLAmismatched cord blood unit, the impact of HLA mismatch on the outcome in CBT has been analyzed extensively. [14][15][16][17][18][19] However, there have been no reports detailing the effect of sex incompatibility on the outcomes after CBT. In this study, we retrospectively analyzed whether donor-recipient sex incompatibility affects the outcomes of myeloablative CBT in 191 adult patients with hematological malignancies in our institute.…”