Different effects of HLA disparity on transplant outcomes after single-unit cord blood transplantation between pediatric and adult patients with leukemia

Yoshiko Atsuta, Junya Kanda, Minoko Takanashi, Yasuo Morishima, Shuichi Taniguchi, Satoshi Takahashi, Hiroyasu Ogawa, Kazuteru Ohashi, Yuju Ohno, Yasushi Onishi, Nobuyuki Aotsuka, Tokiko Nagamura-Inoue, Koji Kato, Yoshinobu Kanda

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    Abstract

    Recent advances in unrelated cord blood transplantation have increased chances and options available in allogeneic stem cell transplantation. The effect of HLA disparity on outcomes after cord blood transplantation was studied recently in mainly pediatric populations. Results showed that HLA matching in combination with total nucleated cell dose positively affects survival. The effect of HLA disparity after single-unit cord blood transplantation may be different in adults because their total nucleated cell dose is much lower compared to pediatric patients. We investigated the effect of HLA disparity on the outcome of single-unit unrelated cord blood transplantation separately in 498 children aged 15 years or under (HLA-A, HLA-B low-resolution, and HLA-DRB1 high-resolution matched [6/6], n=82, and one locus-[5/6], n=222, two loci-[4/6], n=158, three loci-[3/6] mismatched, n=36) and 1,880 adults (6/6, n=71; 5/6, n=309; 4/6, n=1,025; 3/6, n=475) with leukemia. With adjusted analyses, in children, 4/6 showed significantly increased risks of overall mortality (relative risk [RR]=1.61, P=0.042) and transplant-related mortality (RR=3.55, P=0.005) compared to 6/6. The risk of grade 2 to 4 acute GVHD was increased in 5/6 (RR=2.13, P=0.004) and 4/6 (RR=2.65, P<0.001). In adults, the risk of mortality did not increase with the number of mismatched loci (RR=0.99, P=0.944 for 5/6; RR=0.88, P=0.436 for 4/6). The risk of relapse was significantly decreased in 4/6 (RR=0.67, P=0.034). The risk of transplant-related mortality (TRM) or acute GVHD was not increased in 5/6 or 4/6. The effect of HLA disparity on transplant outcome differed between children and adults. In children, an increased number of mismatched HLA loci correlated with an increased risk of mortality. In adults, there was no increase in mortality with an increase in the number of mismatched HLA loci.

    Original languageEnglish
    Pages (from-to)814-822
    Number of pages9
    JournalHaematologica
    Volume98
    Issue number5
    DOIs
    Publication statusPublished - May 2013

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    Fetal Blood
    Leukemia
    Transplantation
    Pediatrics
    Transplants
    Mortality
    HLA-DRB1 Chains
    HLA-A Antigens
    HLA-B Antigens
    Stem Cell Transplantation

    All Science Journal Classification (ASJC) codes

    • Hematology

    Cite this

    Different effects of HLA disparity on transplant outcomes after single-unit cord blood transplantation between pediatric and adult patients with leukemia. / Atsuta, Yoshiko; Kanda, Junya; Takanashi, Minoko; Morishima, Yasuo; Taniguchi, Shuichi; Takahashi, Satoshi; Ogawa, Hiroyasu; Ohashi, Kazuteru; Ohno, Yuju; Onishi, Yasushi; Aotsuka, Nobuyuki; Nagamura-Inoue, Tokiko; Kato, Koji; Kanda, Yoshinobu.

    In: Haematologica, Vol. 98, No. 5, 05.2013, p. 814-822.

    Research output: Contribution to journalArticle

    Atsuta, Y, Kanda, J, Takanashi, M, Morishima, Y, Taniguchi, S, Takahashi, S, Ogawa, H, Ohashi, K, Ohno, Y, Onishi, Y, Aotsuka, N, Nagamura-Inoue, T, Kato, K & Kanda, Y 2013, 'Different effects of HLA disparity on transplant outcomes after single-unit cord blood transplantation between pediatric and adult patients with leukemia', Haematologica, vol. 98, no. 5, pp. 814-822. https://doi.org/10.3324/haematol.2012.076042
    Atsuta, Yoshiko ; Kanda, Junya ; Takanashi, Minoko ; Morishima, Yasuo ; Taniguchi, Shuichi ; Takahashi, Satoshi ; Ogawa, Hiroyasu ; Ohashi, Kazuteru ; Ohno, Yuju ; Onishi, Yasushi ; Aotsuka, Nobuyuki ; Nagamura-Inoue, Tokiko ; Kato, Koji ; Kanda, Yoshinobu. / Different effects of HLA disparity on transplant outcomes after single-unit cord blood transplantation between pediatric and adult patients with leukemia. In: Haematologica. 2013 ; Vol. 98, No. 5. pp. 814-822.
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    AU - Ohashi, Kazuteru

    AU - Ohno, Yuju

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    AU - Aotsuka, Nobuyuki

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    N2 - Recent advances in unrelated cord blood transplantation have increased chances and options available in allogeneic stem cell transplantation. The effect of HLA disparity on outcomes after cord blood transplantation was studied recently in mainly pediatric populations. Results showed that HLA matching in combination with total nucleated cell dose positively affects survival. The effect of HLA disparity after single-unit cord blood transplantation may be different in adults because their total nucleated cell dose is much lower compared to pediatric patients. We investigated the effect of HLA disparity on the outcome of single-unit unrelated cord blood transplantation separately in 498 children aged 15 years or under (HLA-A, HLA-B low-resolution, and HLA-DRB1 high-resolution matched [6/6], n=82, and one locus-[5/6], n=222, two loci-[4/6], n=158, three loci-[3/6] mismatched, n=36) and 1,880 adults (6/6, n=71; 5/6, n=309; 4/6, n=1,025; 3/6, n=475) with leukemia. With adjusted analyses, in children, 4/6 showed significantly increased risks of overall mortality (relative risk [RR]=1.61, P=0.042) and transplant-related mortality (RR=3.55, P=0.005) compared to 6/6. The risk of grade 2 to 4 acute GVHD was increased in 5/6 (RR=2.13, P=0.004) and 4/6 (RR=2.65, P<0.001). In adults, the risk of mortality did not increase with the number of mismatched loci (RR=0.99, P=0.944 for 5/6; RR=0.88, P=0.436 for 4/6). The risk of relapse was significantly decreased in 4/6 (RR=0.67, P=0.034). The risk of transplant-related mortality (TRM) or acute GVHD was not increased in 5/6 or 4/6. The effect of HLA disparity on transplant outcome differed between children and adults. In children, an increased number of mismatched HLA loci correlated with an increased risk of mortality. In adults, there was no increase in mortality with an increase in the number of mismatched HLA loci.

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