Assuntos
Doença Enxerto-Hospedeiro/imunologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Leucemia Mieloide Aguda/terapia , Síndromes Mielodisplásicas/terapia , Linfócitos T/citologia , Transplante Homólogo/efeitos adversos , Adolescente , Adulto , Ensaios Clínicos como Assunto , Humanos , Terapia de Imunossupressão , Incidência , Leucemia Mieloide Aguda/imunologia , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/imunologia , Seleção de Pacientes , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Condicionamento Pré-Transplante , Resultado do Tratamento , Adulto JovemRESUMO
The feasibility of selecting cord blood (CB) units at high-resolution HLA match has not been investigated. We analyzed the high-resolution donor-recipient HLA match of 100 double-unit 4-6/6 HLA-A,-B antigen, -DRB1 allele-matched CB grafts (units 1a and 1b) and their back-up units (n=377 units in total). The median cryopreserved graft dose was 2.9 × 10(7)/kg/unit, and at high resolution these units had a median donor-recipient HLA-allele match of 5/8 (range 2-8/8) and 6/10 (range 2-9/10), respectively. We then evaluated how often use of high-resolution HLA-match criteria would change the original graft selection to substitute one or both of the back-up units for units 1a and/or 1b. On using a model in which both a higher eight-allele HLA match and a cell dose ⩾ 2.0 × 10(7)/kg/unit were required, graft selection changed in 33% of transplants with minimal effect on cell dose (8.3% reduction). In summary, while units chosen based on HLA-A,-B antigen and -DRB1 allele match have substantial mismatch at higher resolution, CB selection based on high-resolution HLA match is possible in a significant proportion of patients without compromise in cell dose.
