Scoring system for optimal cord blood unit selection for single cord blood transplantation

Mizuki Watanabe; Takaaki Konuma; Nobuhiko Imahashi; Seitaro Terakura; Sachiko Seo; Satoko Morishima; Naoyuki Uchida; Noriko Doki; Masatsugu Tanaka; Tetsuya Nishida; Toshiro Kawakita; Tetsuya Eto; Satoshi Takahashi; Masashi Sawa; Yasufumi Uehara; Sung-Won Kim; Fumihiko Ishimaru; Tatsuo Ichinohe; Takahiro Fukuda; Yoshiko Atsuta; Junya Kanda

doi:10.1016/j.jcyt.2023.12.001

Scoring system for optimal cord blood unit selection for single cord blood transplantation

Cytotherapy. 2024 Mar;26(3):286-298. doi: 10.1016/j.jcyt.2023.12.001. Epub 2023 Dec 27.

Authors

Mizuki Watanabe¹, Takaaki Konuma², Nobuhiko Imahashi³, Seitaro Terakura⁴, Sachiko Seo⁵, Satoko Morishima⁶, Naoyuki Uchida⁷, Noriko Doki⁸, Masatsugu Tanaka⁹, Tetsuya Nishida¹⁰, Toshiro Kawakita¹¹, Tetsuya Eto¹², Satoshi Takahashi¹³, Masashi Sawa¹⁴, Yasufumi Uehara¹⁵, Sung-Won Kim¹⁶, Fumihiko Ishimaru¹⁷, Tatsuo Ichinohe¹⁸, Takahiro Fukuda¹⁶, Yoshiko Atsuta¹⁹, Junya Kanda²⁰

Affiliations

¹ Department of Hematology, Kyoto University Hospital, Kyoto, Japan; Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
² Department of Hematology and Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
³ Department of Hematology, National Hospital Organization Nagoya Medical Center, Aichi, Japan.
⁴ Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Aichi, Japan.
⁵ Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan.
⁶ Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Second Department of Internal Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
⁷ Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan.
⁸ Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
⁹ Department of Hematology, Kanagawa Cancer Center, Kanagawa, Japan.
¹⁰ Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan.
¹¹ Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.
¹² Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan.
¹³ Division of Clinical Research Platform, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
¹⁴ Department of Hematology and Oncology, Anjo Kosei Hospital, Aichi, Japan.
¹⁵ Department of Hematology, Kitakyushu City Hospital Organization, Kitakyushu Municipal Medical Center, Fukuoka, Japan.
¹⁶ Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
¹⁷ Japanese Red Cross Kanto-Koshinetsu Block Blood Center, Tokyo, Japan.
¹⁸ Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
¹⁹ Japanese Data Center for Hematopoietic Cell Transplantation, Aichi, Japan; Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Aichi, Japan.
²⁰ Department of Hematology, Kyoto University Hospital, Kyoto, Japan. Electronic address: jkanda16@kuhp.kyoto-u.ac.jp.

PMID: 38149949
DOI: 10.1016/j.jcyt.2023.12.001

Abstract

Background: We conducted a retrospective study to categorize the cord blood unit (CBU)s to identify the optimal units.

Methods: A total of 8503 adults (female, n = 3592; male, n = 4911) receiving their first single cord blood transplantation (CBT) in 2000-2019 were analyzed. Factors associated with CBUs affecting overall survival (OS) and neutrophil engraftment were selected to create ranked categorization for each outcome, followed by comparison with transplantation using HLA-matched bone marrow (BMT)/peripheral blood stem cell (PBSCT) from unrelated (n = 6052) and related donors (n = 4546).

Results: Sex-mismatch, CD34+ cell and CFU-GM counts were selected in the OS analysis. Considering the strong interaction between sex mismatch and CD34+ cell counts, we analyzed females and males separately. For females, female CBU with CD34+ cell counts {greater than or equal to} 0.5 × 10e5/kg and CFU-GM counts {greater than or equal to} 15 × 10e3/kg offered the best OS (Group I), followed by other groups with any (Groups II-IV) or all (Group V) of the risk factors. Group I consistently showed favorable OS (Group IV: HR1.22, P = 0.027; Group V: HR1.31, P = 0.047), comparable to those of rBMT/PBSCT (OS: HR1.02, P = 0.654) and uBM/PBSCT in patients with higher rDRI (HR1.07, P = 0.353). Male patients lacked significant factors affecting OS. Categorization for neutrophil engraftment consisting of CD34+ cell and CFU-GM counts, sex-mismatch, presence of donor-specific antibodies, and the number of HLA-mismatches was effective but not predicted OS.

Conclusion: Our ranked categorizations sufficiently predicted female OS and engraftment. The best-ranked CBUs offered preferable outcomes comparable to conventional BM/PB donors in female but not in male patients.

Keywords: cord blood transplantation; cord blood unit selection.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Antigens, CD34
Bone Marrow Transplantation / adverse effects
Cord Blood Stem Cell Transplantation* / adverse effects
Female
Fetal Blood
Graft vs Host Disease* / etiology
Hematopoietic Stem Cell Transplantation* / adverse effects
Humans
Male
Retrospective Studies

Substances

Antigens, CD34