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Related transplantation with HLA-1 Ag mismatch in the GVH direction and HLA-8/8 allele-matched unrelated transplantation: a nationwide retrospective study.
- Source :
-
Blood [Blood] 2012 Mar 08; Vol. 119 (10), pp. 2409-16. Date of Electronic Publication: 2011 Oct 31. - Publication Year :
- 2012
-
Abstract
- To clarify which is preferable, a related donor with an HLA-1 Ag mismatch at the HLA-A, HLA-B, or HLA-DR loci in the graft-versus-host (GVH) direction (RD/1AG-MM-GVH) or an HLA 8/8-allele (HLA-A, HLA-B, HLA-C, and HLA-DRB1)-matched unrelated donor (8/8-MUD), we evaluated 779 patients with acute leukemia, chronic myelogenous leukemia, or myelodysplastic syndrome who received a T cell-replete graft from an RD/1AG-MM-GVH or 8/8-MUD. The use of an RD/1AG-MM-GVH donor was significantly associated with a higher overall mortality rate than the use of an 8/8-MUD in a multivariate analysis (hazard ratio, 1.49; P < .001), and this impact was statistically significant only in patients with standard-risk diseases (P = .001). Among patients with standard-risk diseases who received transplantation from an RD/1AG-MM-GVH donor, the presence of an HLA-B Ag mismatch was significantly associated with a lower overall survival rate than an HLA-DR Ag mismatch because of an increased risk of treatment-related mortality. The HLA-C Ag mismatch or multiple allelic mismatches were frequently observed in the HLA-B Ag-mismatched group, and were possibly associated with the poor outcome. In conclusion, an 8/8-MUD should be prioritized over an RD/1AG-MM-GVH donor during donor selection. In particular, an HLA-B Ag mismatch in the GVH direction has an adverse effect on overall survival and treatment-related mortality in patients with standard-risk diseases.
- Subjects :
- Acute Disease
Adolescent
Adult
Aged
Female
Graft vs Host Disease genetics
Graft vs Host Disease mortality
HLA Antigens genetics
HLA-A Antigens genetics
HLA-A Antigens immunology
HLA-B Antigens genetics
HLA-B Antigens immunology
HLA-C Antigens genetics
HLA-C Antigens immunology
HLA-DRB1 Chains genetics
HLA-DRB1 Chains immunology
Histocompatibility genetics
Histocompatibility immunology
Humans
Japan
Leukemia genetics
Leukemia immunology
Leukemia surgery
Leukemia, Myelogenous, Chronic, BCR-ABL Positive genetics
Leukemia, Myelogenous, Chronic, BCR-ABL Positive immunology
Leukemia, Myelogenous, Chronic, BCR-ABL Positive surgery
Male
Middle Aged
Multivariate Analysis
Myelodysplastic Syndromes genetics
Myelodysplastic Syndromes immunology
Myelodysplastic Syndromes surgery
Retrospective Studies
Survival Analysis
Survival Rate
Young Adult
Graft vs Host Disease immunology
HLA Antigens immunology
Hematopoietic Stem Cell Transplantation methods
Unrelated Donors
Subjects
Details
- Language :
- English
- ISSN :
- 1528-0020
- Volume :
- 119
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Blood
- Publication Type :
- Academic Journal
- Accession number :
- 22042692
- Full Text :
- https://doi.org/10.1182/blood-2011-08-372573