title: Improved survival in matched unrelated donor transplant for childhood ALL since the introduction of high-resolution matching at HLA class I and II.
abstract: We present the first detailed study analysing OS in BMT for paediatric ALL following the introduction of high-resolution (HR) HLA matching. A total of 356 consecutive paediatric ALL stem cell transplants performed between 1988 and 2007 were reviewed; 80 of them were performed following the introduction of HR HLA class I and class II matching to the transplant programme in 2002. Comparisons of matched unrelated donor (MUD) transplant outcomes before and after this period were made. Matching at the HR level for HLA-A, -B, -C, -DRB1 and -DQB1 (HR-MUD) correlated with a greater than 25% improvement in 2- and 5-year OS in paediatric ALL patients transplanted with MUDs (P=0.009, P=0.005, respectively). Two-year OS for contemporaneous HLA-matched sibling transplants (80.8%) and HR-MUD transplants (78.8%) was equivalent. At 6%, non-relapse mortality (NRM) in MUD transplants since 2002 was significantly reduced compared with previous epochs. Changes in treatment and epoch-dependent improvements in outcome were reviewed for possible confounders to the influence of HR typing using univariate and multivariate analysis.
authors.affiliation: Histocompatibility and Immunogenetics Department, NHS Blood and Transplant, Bristol, UK.
authors.forename: J
authors.initials: J
authors.lastname: Harvey
authors.forename: A
authors.initials: A
authors.lastname: Green
authors.forename: J
authors.initials: J
authors.lastname: Cornish
authors.forename: C
authors.initials: C
authors.lastname: Steward
authors.forename: M
authors.initials: M
authors.lastname: Cummins
authors.forename: L
authors.initials: L
authors.lastname: Keen
authors.forename: S
authors.initials: S
authors.lastname: Culliford
authors.forename: A
authors.initials: A
authors.lastname: Poles
authors.forename: L
authors.initials: L
authors.lastname: Hunt
authors.forename: P
authors.initials: P
authors.lastname: Breslin
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.forename: J
authors.initials: J
authors.lastname: Moppett
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D059866:HLA-DQ beta-Chains; D059811:HLA-DRB1 Chains; D015395:Histocompatibility Antigens Class I; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D015996:Survival Rate; D014184:Transplantation, Homologous; D061349:Unrelated Donors
chemical_list: D059866:HLA-DQ beta-Chains; D059811:HLA-DRB1 Chains; D015395:Histocompatibility Antigens Class I