Risk assessment in haematopoietic stem cell transplantation: impact of donor-recipient sex combination in allogeneic transplantation.
In allogeneic transplantation the donor-recipient sex combination plays a role in outcome. In large retrospective registry studies of several thousands of patients with aplastic anemia, chronic myelocytic leukemia (CML), acute myelocytic leukemia (AML), and multiple myeloma, chronic graft-versus-host disease (cGVHD) was more frequent and transplant-related mortality (TRM) higher in males with a female donor (F-->M) than in other donor-recipient sex combinations. Graft rejection was more frequent in females with a male donor (M-->F) in aplastic anemia, and a graft-versus-tumor effect (GVT) was documented as a reduced relapse rate in F-->M in CML, AML and multiple myeloma. The overall survival was adversely affected in F-->M in aplastic anemia, AML and CML and in M-->F in aplastic anemia. These results support the view that donor T cells specific for male minor histocompatiblity antigens encoded by Y-chromosome genes contribute to GVHD, graft rejection, GVT and survival in sex-mismatched transplants.
Gahrton
Gösta
G
Karolinska Institutet, Department of Medicine and Karolinska University Hospital, Huddinge, SE 14186 Stockholm, Sweden. gosta.gahrton@medhs.ki.se
D000741:Anemia, Aplastic / Q000628:therapy; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006086:Graft vs Host Disease / Q000209:etiology / Q000276:immunology; D020350:Graft vs Tumor Effect / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000276:immunology; D008297:Male; D012008:Recurrence; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D014184:Transplantation, Homologous / Q000009:adverse effects* / Q000401:mortality