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  • Original Article
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Therapy

Unrelated cord blood transplantation vs related transplantation with HLA 1-antigen mismatch in the graft-versus-host direction

Abstract

Little information is available regarding whether an unrelated cord blood (UCB) unit or a related donor with a 1-antigen mismatch at the HLA-A, HLA-B or HLA-DR locus in the graft-versus-host direction (RD/1AG-MM-GVH) should be selected as an alternative donor for patients without an HLA-matched related/unrelated donor. Therefore, we conducted a retrospective study using national registry data on patients with leukemia or myelodysplastic syndrome who received transplantation using a single UCB (n=2288) unit or an RD/1AG-MM-GVH (n=525). We found that the survival rate in the UCB group was comparable to that in the RD/1AG-MM-GVH group, although the RD/1AG-MM-GVH group with an HLA-B mismatch showed significantly higher overall and non-relapse mortality. Neutrophil and platelet engraftment were significantly faster, whereas the incidence of acute or chronic graft-versus-host disease (GVHD) was significantly higher in the RD/1AG-MM-GVH group. The incidence of acute or chronic GVHD in the RD/1AG-MM-GVH group with in vivo T-cell depletion was comparable to that in the UCB group, which translated into a trend toward better overall survival, regardless of the presence of an HLA-B mismatch. In conclusion, UCB and RD/1AG-MM-GVH are comparable for use as an alternative donor, except for RD/1AG-MM-GVH involving an HLA-B mismatch.

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Acknowledgements

We are indebted to all of the physicians and data managers who contributed valuable data on transplantation to the Japan Society for Hematopoietic Cell Transplantation and the Japan Cord Blood Bank Network. We also thank the members of the data management committees of the Japan Society for Hematopoietic Cell Transplantation and the Japan Cord Blood Bank Network for managing data. JK is a research fellow of the Japan Society for the Promotion of Science. This work was supported in part by Grant-in-Aid for JSPS Fellows (JK).

Author contributions

JK and YK designed the research, organized the project and wrote the manuscript; JK, YA, and YK performed the statistical analysis and analyzed the data; KK and TN-I collected data from JCBBN; and all of the authors interpreted the data and reviewed and approved the final manuscript.

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Correspondence to J Kanda.

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Kanda, J., Ichinohe, T., Kato, S. et al. Unrelated cord blood transplantation vs related transplantation with HLA 1-antigen mismatch in the graft-versus-host direction. Leukemia 27, 286–294 (2013). https://doi.org/10.1038/leu.2012.203

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