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Importance of conditioning regimen intensity, MRD positivity, and KIR ligand mismatch in UCB transplantation

Bone Marrow Transplantation volume 53, pages 97–100 (2018)Cite this article

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Minimal residual disease (MRD) is an important factor for the outcomes of allogeneic hematopoietic cell transplantation (alloHCT).1, 2 Milano et al.3 reported that umbilical cord blood transplantation (UCBT) resulted in lower relapse rates in acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) patients with MRD compared with unrelated donor transplantation (URDT). We have shown that intensity of conditioning regimen (that is, myeloablative conditioning (MAC) vs reduced-intensity conditionings (RIC) is critical to overcome the negative effect of MRD before UCBT.4

Donor natural killer (NK) cells are an important part of the GvL effect after alloHCT and its specificity is determined by the killer-Ig receptors (KIRs) on donor NK cells for recipient MHC class I.5 Alloreactive donor-derived (NK) cells improved survival after KIR mismatched URDT in patients with AML.6 Interestingly, this effect has been controversial after UCBT.7, 8, 9, 10 In this study, we analyzed our AML patients in morphologic CR who gave written informed consent for relevant local Institutional Research Board approved UCBT studies between 1 January 2004 and 31 December 2015 to evaluate the effects of MRD, conditioning intensity, and KIRL mismatching on UCBT outcomes.

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Acknowledgements

Author contributions

CU: conceived the study idea, collected the data, analyzed the data, searched the literature, wrote the article and edited the article. JM, MAL, DW: conceived the study idea, analyzed the data, wrote the article and edited the article. TD: collected the data, analyzed the data, wrote the article and edited the article. JM, MAL, DW: conceived the study idea, analyzed data, wrote the article and edited the article. TD: collected the data, analyzed the data, wrote the article and edited the article. CB, AR, SY, NB, SC, EW: analyzed the data, wrote the article and edited the article.

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Authors and Affiliations

  1. Division of Hematology-Oncology and Transplantation, Department of Medicine, Minneapolis, MN, USA

    C Ustun, C Brunstein, A Rashidi, N Bejanyan, S Cooley, E Warlick, J Miller & D Weisdorf

  2. Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA

    T DeFor

  3. Department of Pathology and Laboratory Medicine, University of Minnesota, Minneapolis, MN, USA

    S Yohe & M A Linden

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  1. C Ustun
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  2. C Brunstein
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  3. T DeFor
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  9. J Miller
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  10. M A Linden
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  11. D Weisdorf
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Correspondence to C Ustun.

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Ustun, C., Brunstein, C., DeFor, T. et al. Importance of conditioning regimen intensity, MRD positivity, and KIR ligand mismatch in UCB transplantation. Bone Marrow Transplant 53, 97–100 (2018). https://doi.org/10.1038/bmt.2017.212

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