Isolated HLA-C mismatches in unrelated donor transplantation for CML.
HLA-incompatibility is a major factor associated with outcome of allogeneic stem cell transplantation, but little is known on the impact of isolated HLA-C mismatches. We analyzed the outcome of 114 CML patients transplanted with marrow from unrelated donors of whom 24 were mismatched for HLA-C only (9/10 match). Univariate estimates of 5-year survival (SRV) (median follow-up: 47 months) in the HLA-matched group were 68+/-12 vs 42+/-20% (P=0.03) for the patients mismatched for HLA-C only and 33+/-33% in the mismatched group (non-HLA-C single mismatches and multiple mismatches) (P=0.0004). Disease stage, GVHD-prophylaxis (T-cell depletion), CMV-status and HLA-incompatibility were the risk factors associated (all P< or =0.005) with poor outcome. In the multivariate analysis, patients mismatched for loci other than HLA-C were at high risk of an adverse outcome (death: RR, 2.9; CI, 1.6-5.4, P=0.008, transplant-related mortality (TRM): RR, 3; CI, 1.5-5.9, P=0.0015). For patients mismatched for HLA-C only, the increased risk was of borderline significance (death: RR, 1.9; CI, 1-3.9, P=0.06, TRM: RR, 2.1; CI, 1-4.5, P=0.07). In spite of their lower expression, HLA-C antigens still represent relevant transplantation barriers that should be considered when searching for an unrelated donor.
Tiercy
J-M
JM
Division of Immunology and Allergology, University Hospital, Geneva, Switzerland. Jean-Marie.Tiercy@hcuge.ch
Passweg
J
J
van Biezen
A
A
Zander
A
A
Kröger
N
N
Gratwohl
A
A
Chapuis
B
B
Helg
C
C
Brinch
L
L
Cornelissen
J
J
Oudshoorn
M
M
Ruutu
T
T
Volin
L
L
Niederwieser
D
D
Roosnek
E
E
D000328:Adult; D016026:Bone Marrow Transplantation / Q000276:immunology*; D002423:Cause of Death; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality; D015236:HLA-C Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000276:immunology* / Q000401:mortality / Q000601:surgery*; D019520:Living Donors; D008297:Male; D016609:Neoplasms, Second Primary / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods
D015236:HLA-C Antigens