HLA matching affects clinical outcome of adult patients undergoing haematopoietic SCT from unrelated donors: a study from the Gruppo Italiano Trapianto di Midollo Osseo and Italian Bone Marrow Donor Registry.
The importance of HLA donor-recipient matching in unrelated haematopoietic SCT (HSCT) is the subject of debate. In this retrospective study, we analyzed 805 adult patients from the Italian Registry receiving HSCT for a haematological malignancy from January 1999 to June 2006 and correlated the degree of HLA matching with transplant outcome. All patient-donor pairs had high-resolution typing at HLA-A, -B, -C, -DRB1 and -DQB1. There was a significantly higher risk of overall mortality, non-relapse mortality, graft failure and acute GVHD (aGVHD) for patients receiving HSCT from an unrelated donor with one or more low- or high-resolution mismatch/es (Mm/s). When only a single HLA Mm is present (9/10 matched pairs), mortality risk is higher than among 10/10 matched pairs in patients transplanted with acute leukaemia in the first CR ('early' patients) but not in the other patients (advanced patients): HR=1.69, 95% CI=0.94-3.02, P=0.08; HR=1.03, 95% CI=0.80-1.32, P=0.82, for early and advanced patients, respectively. These results confirm that the advantage of a 10/10 match has a greater effect in early patients, thus suggesting that a 9/10 matched donor can be chosen in patients with advanced disease lacking a rapidly available 10/10 matched one.
Department of Oncology, Hematology and Bone Marrow Transplantation Unit, S Raffaele Scientific Institute, Milano, Italy. crocchiolo.roberto@hsr.it
R
R
Crocchiolo
F
F
Ciceri
K
K
Fleischhauer
R
R
Oneto
B
B
Bruno
S
S
Pollichieni
N
N
Sacchi
M P
MP
Sormani
R
R
Fanin
G
G
Bandini
F
F
Bonifazi
A
A
Bosi
A
A
Rambaldi
P E
PE
Alessandrino
M
M
Falda
A
A
Bacigalupo
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology*; D019337:Hematologic Neoplasms / Q000276:immunology / Q000601:surgery*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D014181:Transplantation Immunology; D016896:Treatment Outcome; D055815:Young Adult
D006680:HLA Antigens