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Blood, 12 March 2009, Vol. 113, No. 11, pp. 2410-2415.
Prepublished online as a Blood First Edition Paper on November 7, 2008; DOI 10.1182/blood-2008-07-163238.


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Submitted July 7, 2008
Accepted November 1, 2008

Acute graft-versus-host disease after unrelated donor umbilical cord blood transplantation: Analysis of risk factors

Margaret L. MacMillan*, Daniel J. Weisdorf, Claudio G Brunstein, Qing Cao, Todd E DeFor, Michael R. Verneris, Bruce R. Blazar, and John E Wagner

Blood and Marrow Transplant Program, University of Minnesota Medical School, Minneapolis, MN, United States
Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, United States
Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States

* Corresponding author; email: macmi002{at}umn.edu.

Acute graft-versus-host disease (GVHD) occurs less frequently after umbilical cord blood transplantation (UCBT). More recent investigations include the use of two partially HLA matched UCB units, or 'double UCB graft', in an effort to meet the minimum cell dose requirement. The purpose of this analysis was to assess the relative risk of acute GVHD in 265 consecutive patients transplanted with UCB graft composed of one (n=80) or two (n=185) units. The incidence of grade III-IV acute GVHD was similar between cohorts. However, the incidence of grade II-IV acute GVHD was higher among double UCBT recipients (58% versus 39%, p < .01). Adjusting for differences between groups, three risk factors for grade II-IV acute GVHD were identified in multiple regression analysis: use of two UCB units, use of non-myeloablative conditioning, and absence of antithymocyte globulin in the conditioning regimen. Transplant-related mortality (TRM) at 1 year, however, was significantly lower after double UCBT (24% versus 39%, p = .02) even if recipients had grade II-IV acute GVHD (20% versus 39%, p = .05). These data suggest that despite a higher incidence of grade II acute GVHD in recipients of two partially HLA matched UCB units, there is no adverse effect on TRM. This study is registered at http://www.cliniclatrials.gov under the identifiers NCT00305682 and NCT00309842.


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