title: Related transplantation with HLA-1 Ag mismatch in the GVH direction and HLA-8/8 allele-matched unrelated transplantation: a nationwide retrospective study.
abstract: To clarify which is preferable, a related donor with an HLA-1 Ag mismatch at the HLA-A, HLA-B, or HLA-DR loci in the graft-versus-host (GVH) direction (RD/1AG-MM-GVH) or an HLA 8/8-allele (HLA-A, HLA-B, HLA-C, and HLA-DRB1)-matched unrelated donor (8/8-MUD), we evaluated 779 patients with acute leukemia, chronic myelogenous leukemia, or myelodysplastic syndrome who received a T cell-replete graft from an RD/1AG-MM-GVH or 8/8-MUD. The use of an RD/1AG-MM-GVH donor was significantly associated with a higher overall mortality rate than the use of an 8/8-MUD in a multivariate analysis (hazard ratio, 1.49; P < .001), and this impact was statistically significant only in patients with standard-risk diseases (P = .001). Among patients with standard-risk diseases who received transplantation from an RD/1AG-MM-GVH donor, the presence of an HLA-B Ag mismatch was significantly associated with a lower overall survival rate than an HLA-DR Ag mismatch because of an increased risk of treatment-related mortality. The HLA-C Ag mismatch or multiple allelic mismatches were frequently observed in the HLA-B Ag-mismatched group, and were possibly associated with the poor outcome. In conclusion, an 8/8-MUD should be prioritized over an RD/1AG-MM-GVH donor during donor selection. In particular, an HLA-B Ag mismatch in the GVH direction has an adverse effect on overall survival and treatment-related mortality in patients with standard-risk diseases.
authors: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors: Junya
authors: J
authors: Kanda
authors: Hiroh
authors: H
authors: Saji
authors: Takahiro
authors: T
authors: Fukuda
authors: Takeshi
authors: T
authors: Kobayashi
authors: Koichi
authors: K
authors: Miyamura
authors: Tetsuya
authors: T
authors: Eto
authors: Mineo
authors: M
authors: Kurokawa
authors: Heiwa
authors: H
authors: Kanamori
authors: Takehiko
authors: T
authors: Mori
authors: Michihiro
authors: M
authors: Hidaka
authors: Koji
authors: K
authors: Iwato
authors: Takashi
authors: T
authors: Yoshida
authors: Hisashi
authors: H
authors: Sakamaki
authors: Junji
authors: J
authors: Tanaka
authors: Keisei
authors: K
authors: Kawa
authors: Yasuo
authors: Y
authors: Morishima
authors: Ritsuro
authors: R
authors: Suzuki
authors: Yoshiko
authors: Y
authors: Atsuta
authors: Yoshinobu
authors: Y
authors: Kanda
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006086:Graft vs Host Disease / Q000235:genetics / Q000276:immunology* / Q000401:mortality; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology*; D015234:HLA-A Antigens / Q000235:genetics / Q000276:immunology; D015235:HLA-B Antigens / Q000235:genetics / Q000276:immunology; D015236:HLA-C Antigens / Q000235:genetics / Q000276:immunology; D059811:HLA-DRB1 Chains / Q000235:genetics / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006648:Histocompatibility / Q000235:genetics / Q000276:immunology; D006801:Humans; D007564:Japan; D007938:Leukemia / Q000235:genetics / Q000276:immunology / Q000601:surgery; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000235:genetics / Q000276:immunology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000235:genetics / Q000276:immunology / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D061349:Unrelated Donors; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D015234:HLA-A Antigens; D015235:HLA-B Antigens; D015236:HLA-C Antigens; D059811:HLA-DRB1 Chains