title: Nonmyeloablative HLA-haploidentical bone marrow transplantation with high-dose posttransplantation cyclophosphamide: effect of HLA disparity on outcome.
abstract: Although some reports have found an association between increasing HLA disparity between donor and recipient and fewer relapses after allogeneic blood or marrow transplantation (BMT), this potential benefit has been offset by more graft-versus-host disease (GVHD) and nonrelapse mortality (NRM). However, the type of GVHD prophylaxis might influence the balance between GVHD toxicity and relapse. The present study analyzed the impact of greater HLA disparity on outcomes of a specific platform for nonmyeloablative (NMA), HLA-haploidentical transplantation. A retrospective analysis was performed of 185 patients with hematologic malignancies enrolled in 3 similar trials of NMA, related donor, haploidentical BMT incorporating high-dose posttransplantation cyclophosphamide for GVHD prophylaxis. No significant association was found between the number of HLA mismatches (HLA-A, -B, -Cw, and -DRB1 combined) and risk of acute grade II-IV GVHD (hazard ratio [HR] = 0.89; P = .68 for 3-4 vs fewer antigen mismatches). More mismatching also had no detrimental effect on event-free survival (on multivariate analysis, HR = 0.60, P = .03 for 3-4 vs fewer antigen mismatches and HR = 0.55, P = .03 for 3-4 vs fewer allele mismatches). Thus, greater HLA disparity does not appear to worsen overall outcome after NMA haploidentical BMT with high-dose posttransplantation cyclophosphamide.
authors.affiliation: Johns Hopkins University, 1650 Orleans Street, Baltimore, MD 21231, USA. ykasamo1@jhmi.edu
authors.forename: Yvette L
authors.initials: YL
authors.lastname: Kasamon
authors.forename: Leo
authors.initials: L
authors.lastname: Luznik
authors.forename: Mary S
authors.initials: MS
authors.lastname: Leffell
authors.forename: Jeanne
authors.initials: J
authors.lastname: Kowalski
authors.forename: Hua-Ling
authors.initials: HL
authors.lastname: Tsai
authors.forename: Javier
authors.initials: J
authors.lastname: Bolaños-Meade
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Morris
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Crilley
authors.forename: Paul V
authors.initials: PV
authors.lastname: O'Donnell
authors.forename: Nancy
authors.initials: N
authors.lastname: Rossiter
authors.forename: Carol Ann
authors.initials: CA
authors.lastname: Huff
authors.forename: Robert A
authors.initials: RA
authors.lastname: Brodsky
authors.forename: William H
authors.initials: WH
authors.lastname: Matsui
authors.forename: Lode J
authors.initials: LJ
authors.lastname: Swinnen
authors.forename: Ivan
authors.initials: I
authors.lastname: Borrello
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Powell
authors.forename: Richard F
authors.initials: RF
authors.lastname: Ambinder
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Jones
authors.forename: Ephraim J
authors.initials: EJ
authors.lastname: Fuchs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000276:immunology / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D006084:Graft Rejection / Q000235:genetics / Q000276:immunology; D006086:Graft vs Host Disease / Q000235:genetics / Q000276:immunology; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology*; D019337:Hematologic Neoplasms / Q000235:genetics / Q000276:immunology / Q000601:surgery*; D006648:Histocompatibility; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007223:Infant; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D012189:Retrospective Studies; D019172:Transplantation Conditioning; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide