title: The impact of HLA unidirectional mismatches on the outcome of myeloablative hematopoietic stem cell transplantation with unrelated donors.
abstract: The impact of HLA homozygosity at mismatched (MM) loci on the outcome of 2687 myeloablative unrelated donor hematopoietic cell transplantations performed for malignant disease was evaluated among 4 groups: 7/8 bidirectional MM transplants (donor and recipient heterozygous MM, n = 1393), 7/8 host-versus-graft (HVG) vector MM (recipient homozygous, n = 112), 7/8 graft-versus-host (GVH) vector MM (donor homozygous, n = 119), and 8/8 matches (n = 1063). Multivariate analyses found 7/8 GVH (P = .001) and bidirectional MM groups (P < .0001) had significantly worse transplant-related mortality and overall and disease-free survival than the 8/8 match group, a difference not observed with the 7/8 HVG MM group (P > .01). The 3 7/8 groups differed only for grades III-IV acute GVH disease (GVHD), where HVG MM had less GVHD than the 7/8 bidirectional MM (hazard ratio [HR] 0.52, P = .0016) and GVH MM (HR 0.43, P = .0009) groups but not the 8/8 group (HR 0.83, P = .39). There were no differences between the 7/8 groups for relapse, chronic GVHD, neutrophil engraftment, or graft failure. GVH MM have the same risk as 7/8 bidirectional MM. 7/8 HVG MM confer a reduced risk of acute GVHD without an increased risk of disease relapse or graft failure compared with a 7/8 bidirectional MM.
authors: Georgetown University, Washington, DC, USA.
authors: Carolyn Katovich
authors: CK
authors: Hurley
authors: Ann
authors: A
authors: Woolfrey
authors: Tao
authors: T
authors: Wang
authors: Michael
authors: M
authors: Haagenson
authors: John
authors: J
authors: Umejiego
authors: Mahmoud
authors: M
authors: Aljurf
authors: Medhat
authors: M
authors: Askar
authors: Minoo
authors: M
authors: Battiwalla
authors: Jason
authors: J
authors: Dehn
authors: John
authors: J
authors: Horan
authors: Machteld
authors: M
authors: Oudshoorn
authors: Joseph
authors: J
authors: Pidala
authors: Wael
authors: W
authors: Saber
authors: Victoria
authors: V
authors: Turner
authors: Stephanie J
authors: SJ
authors: Lee
authors: Stephen R
authors: SR
authors: Spellman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality*; D006680:HLA Antigens / Q000378:metabolism*; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006648:Histocompatibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D019172:Transplantation Conditioning; D061349:Unrelated Donors / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D019653:Myeloablative Agonists
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