1.
ABO incompatibility does not affect transfusion requirements or clinical outcomes of unrelated cord blood transplantation after myeloablative conditioning for haematological malignancies
Chen, Y., Wan, X., Cao, Y., Wang, H., Han, D., Zhang, Y., Yao, W., Song, K., Fan, Q., Zhu, X., et al
Blood transfusion = Trasfusione del sangue. 2021
Abstract
BACKGROUND The effects of ABO incompatibility on cord blood transplantation (CBT) have not been confirmed. We retrospectively investigated the effect of ABO incompatibility on the clinical outcomes and changes of isoagglutinin titres of 261 consecutive patients who underwent CBT in a single centre. MATERIAL AND METHODS We studied patients with haematological malignancies undergoing unrelated CBT following myeloablative conditioning. There were 80 matched, 72 major mismatched, 72 minor mismatched, and 37 bidirectional mismatched transplants. Risk factors that could potentially influence the patients' outcomes were evaluated. Immunoglobulin M (IgM) isohaemagglutinin antibody (IHA) titres were determined 1 day before and 2, 4, 6 and 8 weeks after the transplant. RESULTS ABO mismatches did not influence engraftment, transfusion requirements, event-free survival or overall survival following CBT. The anti-donor IgM serum IHA titres fell to =1:8 at week 8 after CBT in all patients with ABO major and bidirectional mismatches. The percentages of patients requiring platelet and red blood cell transfusions in the period 31-61 days after CBT were markedly lower than in the period 0-30 days after CBT, being 15% vs 99% for platelets and 23% vs 78% for red blood cells, respectively. Of the 69 recipients of minor mismatched CBT tested, only three with AB blood type developed low titres of anti-recipient IHA after 5 months. DISCUSSION In this study ABO incompatibility did not affect clinical outcomes after CBT. A higher number of CD34(+) cells infused was correlated with earlier engraftment. Severe acute graft-versus-host disease was associated with poor overall survival. As the IHA titre decreased, so did the number of patients requiring blood transfusion. Rapidly decreasing anti-donor IHA titres and the non-production of donor anti-recipient A and/or B antibodies might contribute to a good outcome of ABO-incompatible CBT with myeloablative conditioning for haematological malignancies.
2.
Donor KIR2DS1 reduces the risk of transplant related mortality in HLA-C2 positive young recipients with hematological malignancies treated by myeloablative conditioning
Tordai, A., Bors, A., Kiss, K. P., Balassa, K., Andrikovics, H., Batai, A., Szilvasi, A., Rajczy, K., Inotai, D., Torbagyi, E., et al
PloS one. 2019;14(6):e0218945
Abstract
BACKGROUND Recognition of HLA-C2 group alleles on recipient cells by activating killer immunoglobulin like receptors, KIR2DS1 on donor natural killer cells may lead to increased graft-versus-leukemia effect or immunomodulation in patients treated by allogeneic hematopoietic stem cell transplantation (allo-HSCT) influencing disease free and overall survival (OS). OBJECTIVE In the present study, 314 consecutive, allo-HSCT recipient and donor pairs were included with retrospective donor KIR-genotyping and clinical parameters analyzes. RESULTS After a median follow-up of 23.6 months, recipients with HLA-C2 group allele (rC2) showed improved (p = 0.046) OS if transplanted with KIR2DS1 positive donors (d2DS1) compared to those without one or both of this genetic attribute. Within the myeloablative conditioning (MAC) subgroup (n = 227), rC2 homozygous+d2DS1 patients (n = 14) showed a 5 years OS of 93% followed by rC2 heterozygous+d2DS1 patients (n = 48, 65%) compared to rC2 and/or d2DS1 negatives (47%, p = 0.018). Multivariate analyses indicated rC2+d2DS1 positivity as an independent predictor of OS (HR:0.47, 0.26-0.86, p = 0.014) besides donor type, presence of CMV-reactivation or chemoresistant disease. Among MAC-treated patients, the combined rC2+d2DS1 presence was associated with a markedly decreased cumulative incidence of transplant related mortality (p = 0.0045). CONCLUSION The combination of rC2+d2DS1 may be a favorable genetic constellation in allo-HSCT with MAC potentially reducing transplant related mortality.
3.
Comparison of graft-versus-host disease-free, relapse-free survival of transplantation using matched sibling donor, matched unrelated donor or unrelated cord blood after myeloablative conditioning for adult patients with hematological malignancies
Konuma, T., Kato, S., Oiwa-Monna, M., Ishii, H., Tojo, A., Takahashi, S.
Leukemia & Lymphoma. 2016;57(9):2126-32
Abstract
The novel composite endpoint of graft-versus-host disease/relapse-free survival (GRFS) was proposed to evaluate ideal healthy recovery without ongoing morbidity in patients undergoing allogeneic hematopoietic cell transplantation (HCT). We herein analyzed long-term GRFS based on the data of 256 patients with hematological malignancies who underwent allogeneic HCT after myeloablative conditioning. The probabilities of GRFS in the entire cohort were 60.1% at 1 year, and 48.6% at 5 years. Compared with unrelated cord blood, the probability of treatment failure as defined by GRFS at 5 years was similar with matched sibling donor (hazard ratio [HR]: 1.33; p=0.28), but was significantly higher with matched unrelated donor (HR: 1.96; p=0.01) in multivariate analysis. Unrelated cord blood achieved the highest proportion of patients who had not experienced any GRFS events at 5 years. These data suggest that long-term GRFS after HCT was similar in matched sibling donor recipients to unrelated cord blood recipients.