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

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

Abstract

Acute graft-versus-host disease (GVHD) occurs less frequently after umbilical cord blood transplantation (UCBT). More recent investigations include the use of 2 partially human leukocyte antigen (HLA)–matched UCB units, or double UCB graft, 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 receiving transplants with UCB graft composed of 1 (n = 80) or 2 (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 vs 39%, P < .01). Three risk factors for grade II-IV acute GVHD were identified in multiple regression analysis: use of 2 UCB units, use of nonmyeloablative conditioning, and absence of antithymocyte globulin in the conditioning regimen. Transplantation-related mortality (TRM) at 1 year, however, was significantly lower after double UCBT (24 vs 39%, P = .02) even if recipients had grade II-IV acute GVHD (20 vs 39%, P = .05). These data suggest that, despite a higher incidence of grade II acute GVHD in recipients of 2 partially HLA-matched UCB units, there is no adverse effect on TRM. This study is registered at http://www.clinicaltrials.gov under the identifiers NCT00305682 and NCT00309842

Topics: Clinical Trials and Observations
Publisher: American Society of Hematology
OAI identifier: oai:pubmedcentral.nih.gov:2656268
Provided by: PubMed Central
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