Immune Reactions following Cord Blood Transplantations in Adults

Hiroto Narimatsu

doi:10.4061/2011/607569

Abstract

Cord blood transplantation (CBT) is an attractive alternative therapy in adult patients with advanced hematological malignancies in whom matched donors are unavailable. However, the risk of complications, especially infections, post-CBT increases the mortality rates in these patients. Although the incidence of acute and chronic graft versus host disease (GVHD) post-CBT is lower than that following bone marrow transplantation and peripheral blood stem cell transplantation (SCT), the additional immunosuppressive therapy required to treat it could increase the mortality in these patients. Further, chronic GVHD following CBT is milder and responds better to treatment than that occurring after bone marrow transplants. Unlike bone marrow transplantation, the onset of GVHD is a positive prognostic indicator of overall survival in patients receiving CBT, due to the graft versus malignancy (GVM) effect. This paper focuses on the immune reactions following CBT and aims to elucidate a management strategy for acute and chronic GVHD.

Highlights

Cord blood transplantation (CBT) represents an attractive alternative for patients with advanced hematological malignancy who lack matched related or unrelated donors
According to a recent report from Center for International Blood and Marrow Transplant (CIBMT), chronic graft-versus-host disease (GVHD) was developed in 24% of patients, which was significantly lower compared with allele-matched peripheral blood stem cell transplantation (SCT), and matched bone marrow transplantation [44]
The chronic GVHD itself can, in the end, offset the graft versus malignancy (GVM) effect, affecting the overall survival rate and the prognosis of the patient [34, 48, 49]. We surmise that these contrasting results are due to the fact that chronic GVHD following CBT is mild in severity compared to that occurring after bone marrow transplantation

Summary

Introduction

Cord blood transplantation (CBT) represents an attractive alternative for patients with advanced hematological malignancy who lack matched related or unrelated donors. Adult patients receiving myeloablative or reduced-intensity CBT display a 90% chance of engraftment, and experience a 50% rate of transplant-related mortality, mostly attributable to infection [1,2,3,4,5,6]. Unique manifestations of immune reactions that differ from those seen in conventional allogeneic stem cell transplantation (allo-SCT) may occur after CBT. The clinical characteristics of patients with chronic GVHD after CBT have not been well described. I focus on the characteristics of immune reactions following CBT, review the research performed to date in Japan, Europe, and the United States, and attempt to elucidate a management strategy that takes those clinical characteristics into account

Early Immune Reactions and Acute GVHD

Chronic GVHD

Findings

Conclusion