PMID- 23416854
OWN - NLM
STAT- MEDLINE
DCOM- 20131210
LR  - 20211021
IS  - 1523-6536 (Electronic)
IS  - 1083-8791 (Print)
IS  - 1083-8791 (Linking)
VI  - 19
IP  - 6
DP  - 2013 Jun
TI  - Graft-versus-host disease after double-unit cord blood transplantation has unique 
      features and an association with engrafting unit-to-recipient HLA match.
PG  - 904-11
LID - S1083-8791(13)00080-3 [pii]
LID - 10.1016/j.bbmt.2013.02.008 [doi]
AB  - Manifestations of and risk factors for graft-versus-host disease (GVHD) after 
      double-unit cord blood transplantation (DCBT) are not firmly established. We 
      evaluated 115 DCBT recipients (median age, 37 years) who underwent 
      transplantation for hematologic malignancies with myeloablative or 
      nonmyeloablative conditioning and calcineurin inhibitor/mycophenolate mofetil 
      immunosuppression. Incidence of day 180 grades II to IV and III to IV acute GVHD 
      (aGVHD) were 53% (95% confidence interval, 44 to 62) and 23% (95% confidence 
      interval, 15 to 31), respectively, with a median onset of 40 days (range, 14 to 
      169). Eighty percent of patients with grades II to IV aGVHD had gut involvement, 
      and 79% and 85% had day 28 treatment responses to systemic corticosteroids or 
      budesonide, respectively. Of 89 engrafted patients cancer-free at day 100, 54% 
      subsequently had active GVHD, with 79% of those affected having persistent or 
      recurrent aGVHD or overlap syndrome. Late GVHD in the form of classic chronic 
      GVHD was uncommon. Notably, grades III to IV aGVHD incidence was lower if the 
      engrafting unit human leukocyte antigen (HLA)-A, -B, -DRB1 allele match was >4/6 
      to the recipient (hazard ratio, 0.385; P = .031), whereas engrafting unit infused 
      nucleated cell dose and unit-to-unit HLA match were not significant. GVHD after 
      DCBT was common in our study, predominantly affected the gut, and had a high 
      therapy response, and late GVHD frequently had acute features. Our findings 
      support the consideration of HLA- A,-B,-DRB1 allele donor-recipient (but not 
      unit-unit) HLA match in unit selection, a practice change in the field. Moreover, 
      new prophylaxis strategies that target the gastrointestinal tract are needed.
CI  - Copyright (c) 2013 American Society for Blood and Marrow Transplantation. Published 
      by Elsevier Inc. All rights reserved.
FAU - Ponce, D M
AU  - Ponce DM
AD  - Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial 
      Sloan-Kettering Cancer Center, New York, New York, USA.
FAU - Gonzales, A
AU  - Gonzales A
FAU - Lubin, M
AU  - Lubin M
FAU - Castro-Malaspina, H
AU  - Castro-Malaspina H
FAU - Giralt, S
AU  - Giralt S
FAU - Goldberg, J D
AU  - Goldberg JD
FAU - Hanash, A M
AU  - Hanash AM
FAU - Jakubowski, A
AU  - Jakubowski A
FAU - Jenq, R
AU  - Jenq R
FAU - Papadopoulos, E B
AU  - Papadopoulos EB
FAU - Perales, M A
AU  - Perales MA
FAU - van den Brink, M R M
AU  - van den Brink MR
FAU - Young, J W
AU  - Young JW
FAU - Boulad, F
AU  - Boulad F
FAU - O'Reilly, R J
AU  - O'Reilly RJ
FAU - Prockop, S
AU  - Prockop S
FAU - Small, T N
AU  - Small TN
FAU - Scaradavou, A
AU  - Scaradavou A
FAU - Kernan, N A
AU  - Kernan NA
FAU - Stevens, C E
AU  - Stevens CE
FAU - Barker, J N
AU  - Barker JN
LA  - eng
GR  - P01 CA023766/CA/NCI NIH HHS/United States
GR  - P30 CA008748/CA/NCI NIH HHS/United States
GR  - P01 CA23766/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20130214
PL  - United States
TA  - Biol Blood Marrow Transplant
JT  - Biology of blood and marrow transplantation : journal of the American Society for 
      Blood and Marrow Transplantation
JID - 9600628
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Calcineurin Inhibitors)
RN  - 0 (Enzyme Inhibitors)
RN  - 0 (HLA Antigens)
RN  - 0 (Myeloablative Agonists)
RN  - 51333-22-3 (Budesonide)
RN  - EC 3.1.3.16 (Calcineurin)
RN  - HU9DX48N0T (Mycophenolic Acid)
SB  - IM
CIN - Biol Blood Marrow Transplant. 2013 Jun;19(6):847-8. PMID: 23583824
MH  - Adolescent
MH  - Adrenal Cortex Hormones/therapeutic use
MH  - Adult
MH  - Aged
MH  - Budesonide/therapeutic use
MH  - Calcineurin/metabolism
MH  - Calcineurin Inhibitors
MH  - Child
MH  - Child, Preschool
MH  - *Cord Blood Stem Cell Transplantation
MH  - Enzyme Inhibitors/therapeutic use
MH  - Female
MH  - Gastrointestinal Tract/*immunology/pathology
MH  - Graft vs Host Disease/immunology/mortality/pathology/*therapy
MH  - HLA Antigens/*immunology
MH  - Hematologic Neoplasms/immunology/mortality/pathology/*therapy
MH  - Histocompatibility Testing
MH  - Humans
MH  - Infant
MH  - Male
MH  - Middle Aged
MH  - Mycophenolic Acid/analogs & derivatives/therapeutic use
MH  - Myeloablative Agonists/*therapeutic use
MH  - Severity of Illness Index
MH  - Survival Analysis
MH  - *Transplantation Conditioning
MH  - Transplantation, Homologous
MH  - Treatment Outcome
PMC - PMC3673765
MID - NIHMS470801
COIS- Conflict of Interest: The authors have no relevant conflicts of interest to 
      declare.
EDAT- 2013/02/19 06:00
MHDA- 2013/12/16 06:00
PMCR- 2014/06/01
CRDT- 2013/02/19 06:00
PHST- 2012/11/05 00:00 [received]
PHST- 2013/02/09 00:00 [accepted]
PHST- 2013/02/19 06:00 [entrez]
PHST- 2013/02/19 06:00 [pubmed]
PHST- 2013/12/16 06:00 [medline]
PHST- 2014/06/01 00:00 [pmc-release]
AID - S1083-8791(13)00080-3 [pii]
AID - 10.1016/j.bbmt.2013.02.008 [doi]
PST - ppublish
SO  - Biol Blood Marrow Transplant. 2013 Jun;19(6):904-11. doi: 
      10.1016/j.bbmt.2013.02.008. Epub 2013 Feb 14.