title: Recipient/donor HLA and CMV matching in recipients of T-cell-depleted unrelated donor haematopoietic cell transplants.
abstract: Improving haematopoietic cell transplantation outcomes by selection of an HLA-matched unrelated donor is best practice; however, donor selection by secondary characteristics is controversial. We studied 1271 recipients with haematological malignancies who underwent T-cell-depleted allografts and had complete data on HLA-matching status for six loci (HLA-A, -B, -C, -DRB1, -DQB1, -DPB1) and clinical outcome data. Five-year overall survival was 40.6%. HLA mismatching (at HLA-A, -B, -C, -DRB1, -DQB1) relative risk (RR) 1.22, 95% confidence interval (CI) 1.2-1.5, P=0.033 for 1 mismatch and RR 1.46, 95% CI 1.1-1.9, P=0.009 for >1 mismatch) and CMV mismatching (RR 1.37, 95% CI 1.2-1.6, P<0.001) were significantly associated with inferior survival. Donors aged <30 years showed a trend towards better survival. The multivariate model for mortality, combining CMV and HLA-match status, found an RR of 1.36 (95% CI 1.1-1.7, P=0.003) for HLA matched/CMV mismatched, an RR of 1.22 (95% CI 0.99-1.5, P=0.062) for HLA mismatched/CMV matched and an RR of 1.81 (95% CI 1.4-2.3, P=<0.001) for HLA/ CMV mismatched, compared with the HLA/CMV-matched recipients. These data suggest that HLA and CMV matching status should be considered when selecting unrelated donors and that CMV matching may abrogate the effect of an HLA mismatch.
authors.affiliation: Anthony Nolan Research Institute, Royal Free Hospital, London, UK.|CIBMTR and Froedtert and the Medical College of Wisconsin Clinical Cancer Center, Wisconsin, WI, USA.
authors.forename: B E
authors.initials: BE
authors.lastname: Shaw
authors.affiliation: Anthony Nolan Research Institute, Royal Free Hospital, London, UK.|UCL Cancer Institute, Royal Free Campus, London, UK.
authors.forename: N P
authors.initials: NP
authors.lastname: Mayor
authors.affiliation: Anthony Nolan Research Institute, Royal Free Hospital, London, UK.|Imperial College, London, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Szydlo
authors.affiliation: Anthony Nolan Research Institute, Royal Free Hospital, London, UK.
authors.forename: W P
authors.initials: WP
authors.lastname: Bultitude
authors.affiliation: Anthony Nolan Research Institute, Royal Free Hospital, London, UK.|Royal Marsden NHS Foundation Trust, Sutton, UK.
authors.forename: C
authors.initials: C
authors.lastname: Anthias
authors.affiliation: BSBMT, Guy's Hospital, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Kirkland
authors.affiliation: BSBMT, Guy's Hospital, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Perry
authors.affiliation: West of Scotland Cancer Centre, Gartnavel General Hospital, Glasgow, UK.
authors.forename: A
authors.initials: A
authors.lastname: Clark
authors.affiliation: University College London Hospitals, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Mackinnon
authors.affiliation: University Hospitals Bristol NHS Trust, Bristol, UK.
authors.forename: D I
authors.initials: DI
authors.lastname: Marks
authors.affiliation: Kings College Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Pagliuca
authors.affiliation: Royal Marsden NHS Foundation Trust, Sutton, UK.
authors.forename: M N
authors.initials: MN
authors.lastname: Potter
authors.affiliation: Centre for Clinical Haematology, Nottingham University Hospital, Nottingham, UK.
authors.forename: N H
authors.initials: NH
authors.lastname: Russell
authors.affiliation: University College London Hospitals, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Thomson
authors.affiliation: Anthony Nolan Research Institute, Royal Free Hospital, London, UK.|UCL Cancer Institute, Royal Free Campus, London, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Madrigal
authors.affiliation: Anthony Nolan Research Institute, Royal Free Hospital, London, UK.|UCL Cancer Institute, Royal Free Campus, London, UK.
authors.forename: S G E
authors.initials: SGE
authors.lastname: Marsh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000276:immunology*; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006648:Histocompatibility; D006801:Humans; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012698:Serologic Tests; D016019:Survival Analysis; D061349:Unrelated Donors / Q000600:supply & distribution*; D055815:Young Adult
chemical_list: D006680:HLA Antigens