title: Impact on outcomes of human leukocyte antigen matching by allele-level typing in adults with acute myeloid leukemia undergoing umbilical cord blood transplantation.
abstract: This retrospective study analyzed the impact of directional donor-recipient human leukocyte antigen (HLA) disparity using allele-level typing at HLA-A, -B, -C, and -DRB1 in 79 adults with acute myeloid leukemia (AML) who received single-unit umbilical cord blood (UCB) transplant at a single institution. With extended high-resolution HLA typing, the donor-recipient compatibility ranged from 2/8 to 8/8. HLA disparity showed no negative impact on nonrelapse mortality (NRM), graft-versus-host (GVH) disease or engraftment. Considering disparities in the GVH direction, the 5-year cumulative incidence of relapse was 44% and 22% for patients receiving an UCB unit matched ≥ 6/8 and < 6/8, respectively (P = .04). In multivariable analysis, a higher HLA disparity in the GVH direction using extended high-resolution typing (Risk ratio [RR] 2.8; 95% confidence interval [CI], 1.5 to 5.1; P = .0009) and first complete remission at time of transplantation (RR 2.1; 95% CI, 1.2 to 3.8; P = .01) were the only variables significantly associated with an improved disease-free survival. In conclusion, we found that in adults with AML undergoing single-unit UCBT, an increased number of HLA disparities at allele-level typing improved disease-free survival by decreasing the relapse rate without a negative effect on NRM.
authors: Jaime
authors: J
authors: Sanz
authors: Francisco J
authors: FJ
authors: Jaramillo
authors: Dolores
authors: D
authors: Planelles
authors: Pau
authors: P
authors: Montesinos
authors: Ignacio
authors: I
authors: Lorenzo
authors: Federico
authors: F
authors: Moscardó
authors: Guillermo
authors: G
authors: Martin
authors: Francisca
authors: F
authors: López
authors: Jesús
authors: J
authors: Martínez
authors: Isidro
authors: I
authors: Jarque
authors: Javier
authors: J
authors: de la Rubia
authors: Luis
authors: L
authors: Larrea
authors: Miguel A
authors: MA
authors: Sanz
authors: Guillermo F
authors: GF
authors: Sanz
mesh_terms: D000293:Adolescent; D000328:Adult; D000483:Alleles; D036101:Cord Blood Stem Cell Transplantation; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000517:prevention & control; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000235:genetics* / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D006680:HLA Antigens; D019653:Myeloablative Agonists