Journal
BLOOD
Volume 115, Issue 4, Pages 757-765Publisher
AMER SOC HEMATOLOGY
DOI: 10.1182/blood-2009-07-228999
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Funding
- University of Washington Institute of Translational Health Sciences [UL1RR025014]
- Fred Hutchinson Cancer Research Center Core Center for Excellence in Hematology [R24 HL74445, K23 HL077446, T32 CA 009515-24]
- Damon Runyon Cancer Research Foundation [CI 35-07]
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We investigated the potential role of an immune reaction in mediating the dominant engraftment of 1 cord blood unit in 14 patients who received a double-unit cord blood transplantation (CBT). In 10 patients, dominant engraftment of a single donor unit emerged by day 28 after CBT. In 9 of these 10 patients, a significant subset of CD8(+) CD45RO(+/-)CCR7(-) T cells, present in peripheral blood mononuclear cells and derived from the engrafting cord blood unit, produced interferon-gamma (IFN-gamma) in response to the nonengrafting unit. No significant population of IFN-gamma-secreting cells was detectable when posttransplantation peripheral blood mononuclear cells were stimulated against cells from the engrafted unit (P < .001) or from a random human leukocyte antigen disparate third party (P = .003). Three patients maintained persistent mixed chimerism after CBT, and no significant IFN-gamma-secreting cells were detected after similar stimulations in these patients (P < .005). Our data provide the first direct evidence in human double-unit CBT recipients that immune rejection mediated by effector CD8(+) T cells developing after CBT from naive precursors is responsible for the failure of 1 unit to engraft. Future investigations based on these findings may result in strategies to predict a dominant unit and enhance graft-versus-leukemia effect. (Blood. 2010;115:757-765)
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