101. Nonmyeloablative HLA-Haploidentical BMT with High-Dose Posttransplantation Cyclophosphamide: Effect of HLA Disparity on Outcome
- Author
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Kasamon, Yvette L., Luznik, Leo, Leffell, Mary S., Kowalski, Jeanne, Tsai, Hua-Ling, Bolanos-Meade, Javier, Morris, Lawrence E., Crilley, Pamela A., O’Donnell, Paul V., Rossiter, Nancy, Huff, Carol Ann, Brodsky, Robert A., Matsui, William H., Swinnen, Lode J., Borrello, Ivan, Powell, Jonathan D., Ambinder, Richard F., Jones, Richard J., and Fuchs, Ephraim J.
- Subjects
Adult ,Graft Rejection ,Male ,Transplantation Conditioning ,Adolescent ,Graft vs Host Disease ,Article ,Disease-Free Survival ,Young Adult ,immune system diseases ,HLA Antigens ,Recurrence ,Humans ,Child ,Cyclophosphamide ,Aged ,Bone Marrow Transplantation ,Retrospective Studies ,Infant ,Middle Aged ,surgical procedures, operative ,Treatment Outcome ,Child, Preschool ,Hematologic Neoplasms ,Histocompatibility ,Multivariate Analysis ,Female ,Immunosuppressive Agents - Abstract
Although some reports have found increasing HLA disparity between donor and recipient to be associated with fewer relapses after allogeneic blood or marrow transplantation (BMT), this potential benefit has been offset by more graft-versus-host disease (GVHD) and nonrelapse mortality. However, the type of GVHD prophylaxis could influence the balance between GVHD toxicity and relapse. We analyzed the impact of greater HLA disparity on outcomes of a specific platform for nonmyeloablative, HLA-haploidentical transplantation. A retrospective analysis was performed on 185 patients with hematologic malignancies enrolled on three similar trials of nonmyeloablative, related donor, haploidentical BMT incorporating high-dose posttransplantation cyclophosphamide for GVHD prophylaxis. No significant association was found between the number of HLA mismatches (HLA-A, -B, -Cw, and -DRB1 combined) and risk of acute grade II–IV GVHD (hazard ratio .89, P = .68 for 3–4 versus fewer antigen mismatches). More mismatching also had no detrimental effect on event-free survival (on multivariate analysis, hazard ratio .60, P = .03 for 3–4 versus fewer antigen mismatches; hazard ratio .55, P = .03 for 3–4 versus fewer allele mismatches). Thus, greater HLA disparity does not appear to worsen overall outcomes after nonmyeloablative haploidentical BMT with high-dose posttransplantation cyclophosphamide.
- Published
- 2010