Effect of HLA-Matching Recipients to Donor Noninherited Maternal Antigens on Outcomes after Mismatched Umbilical Cord Blood Transplantation for Hematologic Malignancy

Vanderson Rocha, Stephen Spellman, Mei Jie Zhang, Annalisa Ruggeri, Duncan Purtill, Colleen Brady, Lee Ann Baxter-Lowe, Etienne Baudoux, Paola Bergamaschi, Robert Chow, Brian Freed, Gesine Koegler, Joanne Kurtzberg, Jerome Larghero, Lucilla Lecchi, Arnon Nagler, Cristina Navarrette, Vinod Prasad, Fabienne Pouthier, Thomas PriceVoravit Ratanatharathorn, Jon J. van Rood, Mary M. Horowitz, Eliane Gluckman, Mary Eapen

Research output: Contribution to journalArticle

Abstract

Transplantation-related mortality (TRM) is high after HLA-mismatched umbilical cord blood (UCB) transplantation (UCBT). In utero, exposure to noninherited maternal antigen (NIMA) is recognized by the fetus, which induces T regulator cells to that haplotype. It is plausible that UCBTs in which recipients are matched to donor NIMAs may alleviate some of the excess mortality associated with this treatment. To explore this concept, we used marginal matched-pair Cox regression analysis to compare outcomes in 48 NIMA-matched UCBTs (ie, the NIMA of the donor UCB unit matched to the patient) and in 116 non-NIMA-matched UCBTs. All patients had a hematologic malignancy and received a single UCB unit. Cases and controls were matched on age, disease, disease status, transplantation-conditioning regimen, HLA match, and infused cell dose. TRM was lower after NIMA-matched UCBTs compared with NIMA-mismatched UCBTs (relative risk, 0.48; P = .05; 18% versus 32% at 5 years posttransplantation). Consequently, overall survival was higher after NIMA-matched UCBT. The 5-year probability of overall survival was 55% after NIMA-matched UCBTs versus 38% after NIMA-mismatched UCBTs (P = .04). When faced with the choice of multiple HLA-mismatched UCB units containing adequate cell doses, selecting an NIMA-matched UCB unit may improve survival after mismatched UCBT.

Original languageEnglish
Pages (from-to)1890-1896
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume18
Issue number12
DOIs
Publication statusPublished - Dec 2012

Keywords

  • Fetal immune response
  • Permissive match
  • Regulatory T cells

ASJC Scopus subject areas

  • Transplantation
  • Hematology

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    Rocha, V., Spellman, S., Zhang, M. J., Ruggeri, A., Purtill, D., Brady, C., Baxter-Lowe, L. A., Baudoux, E., Bergamaschi, P., Chow, R., Freed, B., Koegler, G., Kurtzberg, J., Larghero, J., Lecchi, L., Nagler, A., Navarrette, C., Prasad, V., Pouthier, F., ... Eapen, M. (2012). Effect of HLA-Matching Recipients to Donor Noninherited Maternal Antigens on Outcomes after Mismatched Umbilical Cord Blood Transplantation for Hematologic Malignancy. Biology of Blood and Marrow Transplantation, 18(12), 1890-1896. https://doi.org/10.1016/j.bbmt.2012.07.010