title: Low incidence of severe acute graft-versus-host disease in children given haematopoietic stem cell transplantation from unrelated donors prospectively matched for HLA class I and II alleles with high-resolution molecular typing.
abstract: We evaluated the outcome of 63 children given haematopoietic stem cell transplantation from unrelated donors (URD-HSCT) prospectively selected using DNA high-resolution typing of both HLA class I and class II loci. Thirty patient/donor pairs (48%) were fully matched. Among the others, HSCT was performed in the presence of one (n=22), two (n=9), or three (n=2) HLA disparities. Patients had either malignant (n=46) or non-malignant (n=17) disease. In all cases, graft-versus-host disease (GVHD) prophylaxis consisted of cyclospor-in A, short-term methotrexate and pretransplant anti-thymocyte globulin. The probability of haematopoietic recovery at day 100 was 97%. Two patients experienced primary graft failure. The cumulative probability of grades III-IV acute GVHD and of extensive chronic GVHD equalled 8 and 14%, respectively. A total of 12 patients died of transplant-related complications. The probability of transplant-related mortality (TRM) at 100 and 180 days was 10 and 15%, respectively, whereas the cumulative incidence of TRM was 22%. The probability of GVHD-related mortality equalled 6% at 2.5 years. The overall and disease-free survival rates were 67 and 65%, respectively. URD-HSCT with donor selection based on high-resolution HLA typing is associated with low incidence of both severe acute GVHD and graft failure. The observed outcome is comparable to that of children transplanted from HLA-identical siblings.
authors.affiliation: Oncoematologia Pediatrica, IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Giebel
authors.forename: G
authors.initials: G
authors.lastname: Giorgiani
authors.forename: M
authors.initials: M
authors.lastname: Martinetti
authors.forename: M
authors.initials: M
authors.lastname: Zecca
authors.forename: R
authors.initials: R
authors.lastname: Maccario
authors.forename: L
authors.initials: L
authors.lastname: Salvaneschi
authors.forename: J
authors.initials: J
authors.lastname: Holowiecki
authors.forename: F
authors.initials: F
authors.lastname: Locatelli
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006086:Graft vs Host Disease / Q000453:epidemiology*; D006681:HLA-D Antigens / Q000235:genetics; D006402:Hematologic Diseases / Q000145:classification / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D015395:Histocompatibility Antigens Class I / Q000235:genetics; D006650:Histocompatibility Testing; D006801:Humans; D015994:Incidence; D007223:Infant; D008875:Middle Aged; D011336:Probability; D015996:Survival Rate; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome
chemical_list: D006681:HLA-D Antigens; D015395:Histocompatibility Antigens Class I