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New sources for argument: do HLA-C and HLA disparity in adult double umbilical cord blood transplants predict outcomes?

Bone Marrow Transplantation volume 51, pages 1256–1258 (2016)Cite this article

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Umbilical cord blood (CB) remains an important alternative hematopoietic stem cell source for patients in need of an allogeneic transplant, strengthened by decreased matching requirements at HLA-A, -B and -DRB1 compared to an adult donor.1, 2 A minimum total nucleated cell (TNC) dose of ⩾2.5 × 107 cells/kg is necessary to decrease the risk of engraftment failure in CB transplants.1, 3 To achieve this TNC, two CB units are often required in adults. Following double unit cord blood transplant (DUCBT), only one of the two units typically provides long-term engraftment. The factors predicting which unit predominates remain elusive. Total cell dose, order of infusion and HLA- A, -B and -DRB1 matching have been assessed without definitive results; however, recent data suggest that the unit with the larger CD34+ cell dose may be predictive.4, 5, 6

Recipients of an HLA-C-mismatched unit experience increased transplant-related mortality (TRM) compared to HLA-C-matched single CB transplants, but its impact on outcomes in DUCBT recipients has not been widely studied.5 As the predominating unit has a sustained immune response or ‘argument’ against the non-predominating unit, HLA mismatching between the two CB units may affect transplant-associated outcomes.7 Therefore, we retrospectively examined the effect of HLA-C and overall HLA matching on unit dominance and donor–donor (D–D) interactions on DUCBT outcomes.

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Authors and Affiliations

  1. Colorado Blood Cancer Institute, Denver, CO, USA

    M T Tees

  2. Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    B Betts, R Hillgruber, E Ayala, T Field, M A Kharfan-Dabaja, F Locke, A Mishra, T Nishihori, J L Ochoa-Bayona, L Perez, J Pidala, C Anasetti & H Fernandez

  3. Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA

    B Betts, R Hillgruber, E Ayala, T Field, M A Kharfan-Dabaja, F Locke, A Mishra, T Nishihori, J L Ochoa-Bayona, L Perez, J Pidala, C Anasetti & H Fernandez

  4. Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    M L Riches

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  1. M T Tees
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Correspondence to M T Tees.

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Tees, M., Betts, B., Hillgruber, R. et al. New sources for argument: do HLA-C and HLA disparity in adult double umbilical cord blood transplants predict outcomes?. Bone Marrow Transplant 51, 1256–1258 (2016). https://doi.org/10.1038/bmt.2016.105

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