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. 2009 Mar 12;113(11):2410-5.
doi: 10.1182/blood-2008-07-163238. Epub 2008 Nov 7.

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

Margaret L MacMillan  1 , Daniel J Weisdorf, Claudio G Brunstein, Qing Cao, Todd E DeFor, Michael R Verneris, Bruce R Blazar, John E Wagner
Affiliations

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

Margaret L MacMillan et al. Blood. .

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.

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Figures

Figure 1
Figure 1
Cumulative incidence of grade II-IV acute GVHD by number of UCB units transplanted.
Figure 2
Figure 2
Maximum stage of acute GVHD by organ system in recipients of a single and double UCB transplant.
Figure 3
Figure 3
Cumulative incidence of grade II-IV acute GVHD in recipients by conditioning regimen. (Left panel) Recipients of myeloablative conditioning regimen. (Right panel) Recipients of nonmyeloablative conditioning regimen.
Figure 4
Figure 4
Cumulative incidence of grade II-IV acute GVHD by HLA match of the engrafted UCB unit.
Figure 5
Figure 5
Cumulative incidence of TRM at 1 year after transplantation. (Left panel) All patients. (Right panel) Patients with grade II-IV acute GVHD.
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References

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