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Impact of Human Leukocyte Antigen Allele Mismatch in Unrelated Bone Marrow Transplantation with Reduced-Intensity Conditioning Regimen
- Source :
- Biology of Blood and Marrow Transplantation. 23:300-309
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
Abstract
- The impact of HLA mismatch in hematopoietic stem cell transplantation with reduced-intensity conditioning (RIC) has not been fully examined. We analyzed a total of 1130 cases to examine the effects of HLA allele mismatch in unrelated bone marrow transplantation (BMT) with RIC in the Japan Marrow Donor Program registry cohort. Compared with HLA 8/8–allele match (n = 720, 8/8 match), both 1 (n = 295, 7/8 match) and 2 allele mismatches (n = 115, 6/8 match) were associated with significant reduction of overall survival (OS) (hazard ratio [HR], 1.34; P = .0024 and HR, 1.33; P = .035 for 7/8 and 6/8 match, respectively). The incidence of grades 2 to 4 acute graft-versus-host disease (aGVHD) increased with increasing number of mismatched alleles (HR, 1.36 and HR, 2.08 for 7/8 and 6/8 match, respectively). Nonrelapse mortality showed a similar tendency to aGVHD (HR, 1.35 for 7/8 and HR, 1.63 for 6/8). One-allele mismatches at the HLA-A or -B and HLA-C loci were significantly associated with inferior OS compared with 8/8 match (HR, 1.64 for A or B mismatch and HR, 1.41 for C mismatch), whereas HLA-DRB1 allele mismatch was not (HR, 1.16; P = .30). However, the effect of HLA-A or -B and -C mismatch on OS was not observed in those who received RIC BMT since 2010, in contrast to recipients before 2010. These results suggested that in unrelated RIC BMT, 1-allele mismatch is associated with poorer outcome, and the impact of HLA mismatch may differ depending on the HLA locus, although these HLA mismatch effects may be different in recent cases.
- Subjects :
- Adult
Male
Risk
Oncology
medicine.medical_specialty
Transplantation Conditioning
Adolescent
Neutrophils
medicine.medical_treatment
Graft vs Host Disease
Locus (genetics)
Kaplan-Meier Estimate
Hematopoietic stem cell transplantation
Human leukocyte antigen
Disease-Free Survival
Leukocyte Count
Young Adult
03 medical and health sciences
0302 clinical medicine
HLA Antigens
Internal medicine
Living Donors
medicine
Humans
Allele
Busulfan
Melphalan
Aged
Bone Marrow Transplantation
Retrospective Studies
Transplantation
business.industry
Hazard ratio
Hematology
Middle Aged
Allografts
HLA Mismatch
Surgery
Regimen
Hematologic Neoplasms
Histocompatibility
030220 oncology & carcinogenesis
Cohort
Female
business
Whole-Body Irradiation
030215 immunology
Subjects
Details
- ISSN :
- 10838791
- Volume :
- 23
- Database :
- OpenAIRE
- Journal :
- Biology of Blood and Marrow Transplantation
- Accession number :
- edsair.doi.dedup.....9e951f6679408811aa92bb1d7efe6ee5