title: Allogeneic hematopoietic stem cell transplantation from family members other than HLA-identical siblings over the last decade (1991-2000).
abstract: The reported outcome of hematopoietic stem cell transplantation (HSCT) from HLA-mismatched family members has been inconsistent. The object of this study was to evaluate the true impact of HLA-mismatch by using recent data from a homogenous population, excluding HSCT procedures that used graft manipulations, and by considering genotypic matching. Clinical data of 2947 patients who underwent allogeneic HSCT for leukemia or myelodysplastic syndrome were extracted from the database of the Japan Society for Hematopoietic Cell Transplantation. The main outcome measures were survival and the incidence of graft-versus-host disease (GVHD). The presence of serologic HLA-mismatch, higher age, and high-risk disease were identified as independent risk factors for both shorter survival and the development of grade III to IV acute GVHD. The impact of HLA-mismatch on survival was more relevant in standard-risk patients. These findings persisted when we used genotypic HLA matching. Survival after one-locus-mismatched HSCT was equivalent to that after HLA-matched unrelated HSCT. We concluded that when a one-locus-mismatched family donor is available for high-risk patients, immediate HSCT using this donor is warranted. In standard-risk patients, however, survival after one-locus-mismatched HSCT is significantly shorter than that after HLA-matched HSCT, and the indications for HSCT should be considered carefully.
authors.affiliation: Department of Cell Therapy and Transplantation Medicine, University of Tokyo Hospital, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
authors.forename: Shigeru
authors.initials: S
authors.lastname: Chiba
authors.forename: Hisamaru
authors.initials: H
authors.lastname: Hirai
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.forename: Tohru
authors.initials: T
authors.lastname: Iseki
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kodera
authors.forename: Takahiro
authors.initials: T
authors.lastname: Karasuno
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Okamoto
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Hirabayashi
authors.forename: Koji
authors.initials: K
authors.lastname: Iwato
authors.forename: Atsuo
authors.initials: A
authors.lastname: Maruta
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Fujimori
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Furukawa
authors.forename: Shin
authors.initials: S
authors.lastname: Mineishi
authors.forename: Keitaro
authors.initials: K
authors.lastname: Matsuo
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hamajima
authors.forename: Masahiro
authors.initials: M
authors.lastname: Imamura
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D005190:Family; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D006680:HLA Antigens / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D007938:Leukemia / Q000628:therapy; D008297:Male; D009190:Myelodysplastic Syndromes / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D035781:Siblings; D015996:Survival Rate; D014019:Tissue Donors; D014181:Transplantation Immunology; D014184:Transplantation, Homologous
chemical_list: D006680:HLA Antigens