Relative Impact of HLA Matching and Non-HLA Donor Characteristics on Outcomes of Allogeneic Stem Cell Transplantation for Acute Myeloid Leukemia and Myelodysplastic Syndrome

被引：51

作者：

Ayuk, Francis ^{[1
]}

Beelen, Dietrich W. ^{[2
,3
]}

Bornhaeuser, Martin ^{[4
]}

Stelljes, Matthias ^{[5
]}

Zabelina, Tatjana ^{[1
]}

Finke, Juergen ^{[6
]}

Kobbe, Guido ^{[7
]}

Wolff, Daniel ^{[8
]}

Wagner, Eva-Maria ^{[9
]}

Christopeit, Maximilian ^{[1
]}

Schmid, Christoph ^{[10
]}

Ottinger, Hellmut ^{[3
]}

Groth, Christoph ^{[5
]}

Faul, Christoph ^{[11
]}

Bertz, Hartmut ^{[6
]}

Rachlis, Elena ^{[7
]}

Wolschke, Christine ^{[1
]}

Schetelig, Johannes ^{[3
,4
]}

Horn, Peter A. ^{[12
]}

Mytilineos, Joannis

Guellstorf, Martina ^{[1
]}

Kelsch, Reinhard ^{[13
]}

Fleischhauer, Katharina ^{[14
]}

Kroeger, Nicolaus ^{[1
]}

Bethge, Wolfgang ^{[11
]}

机构：

[1] Univ Med Ctr Hamburg Eppendorf, Dept Stem Cell Transplantat, Hamburg, Germany

[2] Univ Hosp Essen, West German Canc Ctr, Dept Bone Marrow Transplant, Essen, Germany

[3] DRST, German Registry Stem Cell Transplantat, Essen, Germany

[4] Univ Hosp TU, Med Clin & Policlin 1, Dresden, Germany

[5] Univ Klinikum Munster, Med Klin A, Munster, Germany

[6] Univ Med Ctr Freiburg, Hematol Oncol, Freiburg, Germany

[7] Heinrich Heine Univ, Dept Hematol Oncol & Clin Immunol, Dusseldorf, Germany

[8] Univ Hosp Regensburg, Dept Hematol & Med Oncol, Regensburg, Germany

[9] Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med Hematol Oncol & Pneumol 3, Mainz, Germany

[10] Klinikum Augsburg, Dept Haematol & Oncol, Augsburg, Germany

[11] Eberhard Karls Univ Tubingen, Dept Hematol & Oncol, Tubingen, Germany

[12] Univ Hosp Essen, Dept Transfus Med, Essen, Germany

[13] Univ Munster, Dept Transfus Med, Munster, Germany

[14] Univ Hosp Essen, Inst Expt Cellular Therapy, Essen, Germany

来源：

BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION | 2018年 / 24卷 / 12期

关键词：

HLA disparity; Non-HLA donor characteristics; BONE-MARROW-TRANSPLANTATION; UNRELATED DONOR; COMPARABLE SURVIVAL; IDENTICAL SIBLINGS; GRAFT; RISK; MISMATCH; BLOOD; ALLOREACTIVITY; RECIPIENTS;

D O I：

10.1016/j.bbmt.2018.06.026

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Increasing donor-recipient HLA disparity is associated with negative outcomes of allogeneic hematopoietic stem cell transplantation (HSCT), but its comparative relevance amid non-HLA donor characteristics is not well established. We addressed this question in 3215 HSCTs performed between 2005 and 2013 in Germany for acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). Donors were HLA-matched related (MRD; n = 872) or unrelated (10/10 MUD, n =1553) or HLA-mismatched unrelated (<10/10 MMUD, n = 790). Overall survival (OS) was similar after MRD compared with 10/10 MUD HSCT, reflecting opposing hazards of relapse (hazard ratio [HR], 132; P < .002) and non-relapse mortality (HR, .63; P < .001). After UD HSCT, increasing HLA disparity was associated with inferior OS (HR, 1.21 [P < .02] and HR, 1.57 [P < .001] for 9/10 and <= 8/10 MMUD, respectively, compared with 10/10 MUD). Among non-HLA donor characteristics, age, sex mismatching (male recipient-female donor), and cytomegalovirus (CMV) mismatching (positive recipient-negative donor) impacted OS. Multivariate subgroup analysis showed that OS was similar after HSCT from the youngest 9/10 MMUD (<30 years) compared with the oldest 10/10 MUD (>40 years) (HR, 1.18; P= .25) and also in male patients transplanted from female 10/10 MUD compared with male 9/10 MMUD (HR, .89; P= .46). In contrast OS of CMV-positive patients tended to be better with CMV-negative 10/10 MUDs compared with CMV-positive 9/10 MMUDs (HR, 1.31; P = .04). Because of low patient numbers in subgroups, definite conclusions and establishment of a hierarchy among HLA matching and non-HLA donor characteristics could not be made. Our data suggest that the impact of donor age and sex mismatch but not CMV mismatch on outcome of allogeneic HSCT may be comparable with that of single HLA disparity. (C) 2018 American Society for Blood and Marrow Transplantation.

引用

页码：2558 / 2567

页数：10

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