title: Impact of ABO incompatibility on patients' outcome after haploidentical hematopoietic stem cell transplantation for acute myeloid leukemia - a report from the Acute Leukemia Working Party of the EBMT.
abstract: A significant proportion of hematopoietic stem cell transplants are performed with ABO-mismatched donors. The impact of ABO mismatch on outcome following transplantation remains controversial and there are no published data regarding the impact of ABO mismatch in acute myeloid leukemia patients receiving haploidentical transplants. Using the European Blood and Marrow Transplant Acute Leukemia Working Group registry we identified 837 patients who underwent haploidentical transplantation. Comparative analysis was performed between patients who received ABO-matchedversusABO-mismatched haploidentical transplants for common clinical outcome variables. Our cohort consisted of 522 ABO-matched patients and 315 ABO-mismatched patients including 150 with minor, 127 with major, and 38 with bi-directional ABO mismatching. There were no significant differences between ABO matched and mismatched patients in terms of baseline disease and clinical characteristics. Major ABO mismatching was associated with inferior day 100 engraftment rate whereas multivariate analysis showed that bi-directional mismatching was associated with increased risk of grade II-IV acute graft-versus-host disease [hazard ratio (HR) 2.387; 95% confidence interval (CI): 1.22-4.66;P=0.01). Non-relapse mortality, relapse incidence, leukemia-free survival, overall survival, and chronic graft-versus-host disease rates were comparable between ABO-matched and -mismatched patients. Focused analysis on stem cell source showed that patients with minor mismatching transplanted with bone marrow grafts experienced increased grade II-IV acute graft-versus-host disease rates (HR 2.03; 95% CI: 1.00-4.10;P=0.04). Patients with major ABO mismatching and bone marrow grafts had decreased survival (HR=1.82; CI 95%: 1.048 - 3.18;P=0.033). In conclusion, ABO incompatibility has a marginal but significant clinical effect in acute myeloid leukemia patients undergoing haploidentical transplantation.
authors.affiliation: Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Israel.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Canaani
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.affiliation: Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Hȏpital Saint-Antoine, Paris, France.|INSERM UMR 938, Paris, France.|Université Pierre et Marie Curie, Paris, France.
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.affiliation: Peking University People's Hospital, Institute of Haematology, Xicheng District, Beijing, China.
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Huang
authors.affiliation: Ospedale San Raffaele s.r.l., Haematology and BMT, Milano, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ciceri
authors.affiliation: Tor Vergata University of Rome, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Italy.
authors.forename: William
authors.initials: W
authors.lastname: Arcese
authors.affiliation: Klinikum Grosshadern, Med. Klinik III, Munich, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Tischer
authors.affiliation: Medical Park Hospitals, Stem Cell Transplant Unit, Antalya, Turkey.
authors.forename: Yener
authors.initials: Y
authors.lastname: Koc
authors.affiliation: S.S.C.V.D Trapianto di Cellule Staminali A.O.U Citta della Salute e della Scienza di Torino, Italy.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.affiliation: Anadolu Medical Center Hospital, Bone Marrow Transplantation Department, Kocaeli, Turkey.
authors.forename: Zafer
authors.initials: Z
authors.lastname: Gülbas
authors.affiliation: Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.affiliation: University Hospital Gasthuisberg, Department of Hematology, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Maertens
authors.affiliation: Universitaetsklinikum Dresden Medizinische Klinik und Poliklinik I, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Ehninger
authors.affiliation: Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Hȏpital Saint-Antoine, Paris, France.|INSERM UMR 938, Paris, France.|Université Pierre et Marie Curie, Paris, France.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.affiliation: Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Israel arnon.nagler@sheba.health.gov.il.|Acute Leukemia Working Party-EBMT and Department of Hematology and Cell Therapy, Hȏpital Saint-Antoine, Paris, France.|Université Pierre et Marie Curie, Paris, France.
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000401:mortality; D016022:Case-Control Studies; D005260:Female; D006085:Graft Survival / Q000276:immunology; D006086:Graft vs Host Disease / Q000209:etiology / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation; D006648:Histocompatibility; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D000075442:Transplantation, Haploidentical; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System