title: The impact of HLA matching on long-term transplant outcome after allogeneic hematopoietic stem cell transplantation for CLL: a retrospective study from the EBMT registry.
abstract: We analyzed 368 chronic lymphocytic leukemia patients who underwent allogeneic hematopoietic stem cell transplantation reported to the EBMT registry between 1995 and 2007. There were 198 human leukocyte antigen (HLA)-identical siblings; among unrelated transplants, 31 were well matched in high resolution ('well matched' unrelated donor, WMUD), and 139 were mismatched (MM), including 30 matched in low resolution; 266 patients (72%) received reduced-intensity conditioning and 102 (28%) received standard. According to the EBMT risk score, 11% were in scores 1-3, 23% in score 4, 40% in score 5, 22% in score 6 and 4% in score 7. There was no difference in overall survival (OS) at 5 years between HLA-identical siblings (55% (48-64)) and WMUD (59% (41-84)), P=0.82. In contrast, OS was significantly worse for MM (37% (29-48) P=0.005) due to a significant excess of transplant-related mortality. Also OS worsened significantly when EBMT risk score increased. HLA matching had no significant impact on relapse (siblings: 24% (21-27); WMUD: 35% (26-44), P=0.11 and MM: 21% (18-24), P=0.81); alemtuzumab T-cell depletion and stem cell source (peripheral blood) were associated with an increased risk. Our findings support the use of WMUD as equivalent alternative to HLA-matched sibling donors for allogeneic HSCT in CLL, and justify the application of EBMT risk score in this disease.
authors: Department of Hematology, Edouard Herriot Hospital, Lyon, France. mauricette.michallet@chu-lyon.fr
authors: M
authors: M
authors: Michallet
authors: M
authors: M
authors: Sobh
authors: D
authors: D
authors: Milligan
authors: S
authors: S
authors: Morisset
authors: D
authors: D
authors: Niederwieser
authors: V
authors: V
authors: Koza
authors: T
authors: T
authors: Ruutu
authors: N H
authors: NH
authors: Russell
authors: L
authors: L
authors: Verdonck
authors: N
authors: N
authors: Dhedin
authors: A
authors: A
authors: Vitek
authors: M
authors: M
authors: Boogaerts
authors: L
authors: L
authors: Vindelov
authors: J
authors: J
authors: Finke
authors: V
authors: V
authors: Dubois
authors: A
authors: A
authors: van Biezen
authors: R
authors: R
authors: Brand
authors: T
authors: T
authors: de Witte
authors: P
authors: P
authors: Dreger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control*; D006680:HLA Antigens / Q000378:metabolism*; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000276:immunology / Q000378:metabolism* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D035781:Siblings; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D006680:HLA Antigens