Serologically HLA-DR-mismatched unrelated donors might provide a valuable alternative in allogeneic transplantation: experience from a single japanese institution.
To clarify the clinical significance of a serologic HLA-DR mismatch after unrelated-donor transplantation, we evaluated for hematologic malignancies 123 cases of unrelated bone marrow transplantation carried out in a single institution between 1995 and 2004. Of the patients in these cases, 12 were serologically mismatched at the single HLA-DR locus. Eighty-two patients who received HLA-matched transplantations were used as controls. Conditioning consisted of a conventional total body irradiation-based regimen or a fludarabine-based reduced-intensity regimen. Prophylaxis for graft-versus-host disease (GVHD) consisted of tacrolimus plus short-term methotrexate. Graft failure did not develop. With a median follow-up of 42 months (range, 11-99 months), rates of overall survival, nonrelapse mortality, and relapse at 4 years were 63%, 38%, and 0%, respectively, all of which were comparable with those after HLA-matched transplantation. The frequency of acute GVHD of grades II to IV was 75%, significantly higher than after HLA-matched transplantation (42%, P = .046), and there was a trend toward an increased incidence of acute GVHD of grades III to IV after serologically HLA-DR-mismatched unrelated transplantation (27% versus 10%, P = .093). Chronic GVHD developed in 4 of 11 evaluable patients, an incidence comparable with that after HLA-matched transplantation. In summary, serologically HLA-DR-mismatched unrelated transplantation is feasible and might be an acceptable alternative for the Japanese population, although the higher incidence of acute GVHD is notable.
Inamoto
Yoshihiro
Y
Department of Hematology, Japanese Red Cross Nagoya First Hospital, Aichi, Japan. yinamoto@js3.so-net.ne.jp
Kuwatsuka
Yachiyo
Y
Oba
Taku
T
Terakura
Seitaro
S
Sugimoto
Kyoko
K
Tsujimura
Akane
A
Takahashi
Taro
T
Yasuda
Takahiko
T
Miyamura
Koichi
K
Kodera
Yoshihisa
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D044466:Asian People; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006684:HLA-DR Antigens; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007564:Japan; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D015996:Survival Rate; D016559:Tacrolimus / Q000008:administration & dosage*; D014184:Transplantation, Homologous
D006684:HLA-DR Antigens; D007166:Immunosuppressive Agents; D016559:Tacrolimus; D008727:Methotrexate