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 Blood, 20 August 2009, Vol. 114, No. 8, pp. 1689-1695.
Prepublished online as a Blood First Edition Paper on June 17, 2009; DOI 10.1182/blood-2008-12-194696.

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TRANSPLANTATION

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

Naofumi Matsuno1, Atsushi Wake1, Naoyuki Uchida1, Kazuya Ishiwata1, Hideki Araoka2, Shinsuke Takagi1, Masanori Tsuji1, Hisashi Yamamoto1, Daisuke Kato1, Yoshiko Matsuhashi1, Sachiko Seo1, Kazuhiro Masuoka1, Shigesaburo Miyakoshi1, Shigeyoshi Makino3, Akiko Yoneyama2, Yoshinobu Kanda4, and Shuichi Taniguchi1

1 Department of Hematology, Toranomon Hospital, Tokyo; 2 Department of Infectious Diseases, Toranomon Hospital, Tokyo; 3 Department of Transfusion Medicine, Toranomon Hospital, Tokyo; and 4 Division of Hematology, Saitama Medical Center, Jichi Medical School, Saitama, Japan

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 reduced-intensity 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 host-versus-graft direction. Similarly, the number of HLA class I antigens mismatched in the GVH direction, but not in the host-versus-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 CBT.


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