BACKGROUND: The importance of matching at the HLA C locus has not been well defined for unrelated umbilical-cord blood transplantation. The selection algorithm for umbilical-cord blood units generally considers intermediate resolution HLA typing at A and B and allele-level typing at DRB1. We aimed to establish the relative importance of additional matching at HLA C. METHODS: We used Cox regression to assess retrospectively the effect of donor-recipient HLA matching on outcomes of single umbilical-cord blood transplantations for leukaemia and myelodysplastic syndrome. Our primary endpoint was transplant-related mortality. HLA typing was done with molecular techniques with a minimum of intermediate resolution for HLA A, B, and C, and at the allele-level for DRB1. FINDINGS: The median age of our study population was 10 years (range <1-62) and 552 (69%) of 803 patients were aged 16 years or younger at transplantation. Compared with transplantations matched at HLA A, B, C, and DRB1 (n=69), transplant-related mortality risk was higher after transplantations matched at HLA A, B, and DRB1 and mismatched at HLA C (n=23; HR 3·97, 95% CI 1·27-12·40; p=0·018). Transplant-related mortality risk was also higher after transplantations with a single mismatch at HLA A, B, or DRB1 and mismatched at HLA C (n=234; 1·70, 1·06-2·74; p=0·029) compared with transplantations matched at HLA C with a single mismatch at HLA A, B, or DRB1 (n=127). Assessing the overall effect of HLA disparity on transplant-related mortality, risks were higher with units mismatched at two (n=259; 3·27, 1·42-7·54; p=0·006), three (n=253; 3·34, 1·45-7·71; p=0·005), or four (n=75; 3·51, 1·44-8·58; p=0·006) loci compared with matched units (n=69). INTERPRETATION: Our data suggest that the present strategy for umbilical-cord blood unit selection should be reassessed; matching at HLA C for units that are matched at HLA A, B, or DRB1 or in the presence of a single locus mismatch at HLA A, B, or DRB1 should be included to minimise mortality risks. FUNDING: National Cancer Institute, National Heart Lung and Blood Institute, National Institute for Allergy and Infectious Diseases, Leukemia and Lymphoma Society, US Department of the Navy, Children's Leukemia Research Association, and INSERM.
BACKGROUND: The importance of matching at the HLA C locus has not been well defined for unrelated umbilical-cord blood transplantation. The selection algorithm for umbilical-cord blood units generally considers intermediate resolution HLA typing at A and B and allele-level typing at DRB1. We aimed to establish the relative importance of additional matching at HLA C. METHODS: We used Cox regression to assess retrospectively the effect of donor-recipient HLA matching on outcomes of single umbilical-cord blood transplantations for leukaemia and myelodysplastic syndrome. Our primary endpoint was transplant-related mortality. HLA typing was done with molecular techniques with a minimum of intermediate resolution for HLA A, B, and C, and at the allele-level for DRB1. FINDINGS: The median age of our study population was 10 years (range <1-62) and 552 (69%) of 803 patients were aged 16 years or younger at transplantation. Compared with transplantations matched at HLA A, B, C, and DRB1 (n=69), transplant-related mortality risk was higher after transplantations matched at HLA A, B, and DRB1 and mismatched at HLA C (n=23; HR 3·97, 95% CI 1·27-12·40; p=0·018). Transplant-related mortality risk was also higher after transplantations with a single mismatch at HLA A, B, or DRB1 and mismatched at HLA C (n=234; 1·70, 1·06-2·74; p=0·029) compared with transplantations matched at HLA C with a single mismatch at HLA A, B, or DRB1 (n=127). Assessing the overall effect of HLA disparity on transplant-related mortality, risks were higher with units mismatched at two (n=259; 3·27, 1·42-7·54; p=0·006), three (n=253; 3·34, 1·45-7·71; p=0·005), or four (n=75; 3·51, 1·44-8·58; p=0·006) loci compared with matched units (n=69). INTERPRETATION: Our data suggest that the present strategy for umbilical-cord blood unit selection should be reassessed; matching at HLA C for units that are matched at HLA A, B, or DRB1 or in the presence of a single locus mismatch at HLA A, B, or DRB1 should be included to minimise mortality risks. FUNDING: National Cancer Institute, National Heart Lung and Blood Institute, National Institute for Allergy and Infectious Diseases, Leukemia and Lymphoma Society, US Department of the Navy, Children's Leukemia Research Association, and INSERM.
Authors: Robert A Bray; Carolyn K Hurley; Naynesh R Kamani; Ann Woolfrey; Carlheinz Müller; Stephen Spellman; Michelle Setterholm; Dennis L Confer Journal: Biol Blood Marrow Transplant Date: 2008-09 Impact factor: 5.742
Authors: S N Robinson; J Ng; T Niu; H Yang; J D McMannis; S Karandish; I Kaur; P Fu; M Del Angel; R Messinger; F Flagge; M de Lima; W Decker; D Xing; R Champlin; E J Shpall Journal: Bone Marrow Transplant Date: 2006-02 Impact factor: 5.483
Authors: Michael R Verneris; Claudio G Brunstein; Juliet Barker; Margaret L MacMillan; Todd DeFor; David H McKenna; Michael J Burke; Bruce R Blazar; Jeffrey S Miller; Philip B McGlave; Daniel J Weisdorf; John E Wagner Journal: Blood Date: 2009-08-25 Impact factor: 22.113
Authors: G Bautista; J R Cabrera; C Regidor; R Forés; J A García-Marco; E Ojeda; I Sanjuán; E Ruiz; I Krsnik; B Navarro; S Gil; E Magro; A de Laiglesia; R Gonzalo-Daganzo; T Martín-Donaire; M Rico; I Millán; M N Fernández Journal: Bone Marrow Transplant Date: 2008-10-13 Impact factor: 5.483
Authors: Claudio G Brunstein; Juliet N Barker; Daniel J Weisdorf; Todd E DeFor; Jeffrey S Miller; Bruce R Blazar; Philip B McGlave; John E Wagner Journal: Blood Date: 2007-06-14 Impact factor: 22.113
Authors: Stephanie J Lee; John Klein; Michael Haagenson; Lee Ann Baxter-Lowe; Dennis L Confer; Mary Eapen; Marcelo Fernandez-Vina; Neal Flomenberg; Mary Horowitz; Carolyn K Hurley; Harriet Noreen; Machteld Oudshoorn; Effie Petersdorf; Michelle Setterholm; Stephen Spellman; Daniel Weisdorf; Thomas M Williams; Claudio Anasetti Journal: Blood Date: 2007-09-04 Impact factor: 22.113
Authors: U Sobol; A Go; S Kliethermes; S Bufalino; T Rodriguez; S Smith; M Parthasarathy; P Stiff Journal: Bone Marrow Transplant Date: 2015-09-14 Impact factor: 5.483
Authors: Stephen R Spellman; Mary Eapen; Brent R Logan; Carlheinz Mueller; Pablo Rubinstein; Michelle I Setterholm; Ann E Woolfrey; Mary M Horowitz; Dennis L Confer; Carolyn K Hurley Journal: Blood Date: 2012-05-17 Impact factor: 22.113
Authors: Rohtesh S Mehta; Shernan G Holtan; Tao Wang; Michael T Hemmer; Stephen R Spellman; Mukta Arora; Daniel R Couriel; Amin M Alousi; Joseph Pidala; Hisham Abdel-Azim; Vaibhav Agrawal; Ibrahim Ahmed; A Samer Al-Homsi; Mahmoud Aljurf; Joseph H Antin; Medhat Askar; Jeffery J Auletta; Vijaya Raj Bhatt; Lynette Chee; Saurabh Chhabra; Andrew Daly; Zachariah DeFilipp; James Gajewski; Robert Peter Gale; Usama Gergis; Peiman Hematti; Gerhard C Hildebrandt; William J Hogan; Yoshihiro Inamoto; Rodrigo Martino; Navneet S Majhail; David I Marks; Taiga Nishihori; Richard F Olsson; Attaphol Pawarode; Miguel Angel Diaz; Tim Prestidge; Hemalatha G Rangarajan; Olle Ringden; Ayman Saad; Bipin N Savani; Hélène Schoemans; Sachiko Seo; Kirk R Schultz; Melhem Solh; Thomas Spitzer; Jan Storek; Takanori Teshima; Leo F Verdonck; Baldeep Wirk; Jean A Yared; Jean-Yves Cahn; Daniel J Weisdorf Journal: J Clin Oncol Date: 2020-05-04 Impact factor: 44.544
Authors: Julia Pingel; Tao Wang; Yvonne Hagenlocher; Camila J Hernández-Frederick; Arnon Nagler; Michael D Haagenson; Katharina Fleischhauer; Katharine C Hsu; Michael R Verneris; Stephanie J Lee; Mohamad Mohty; Emmanuelle Polge; Stephen R Spellman; Alexander H Schmidt; Jon J van Rood Journal: Bone Marrow Transplant Date: 2018-10-02 Impact factor: 5.483