Changes in the Clinical Impact of High-Risk Human Leukocyte Antigen Allele Mismatch Combinations on the Outcome of Unrelated Bone Marrow Transplantation
Changes in the Clinical Impact of High-Risk Human Leukocyte Antigen Allele Mismatch Combinations on the Outcome of Unrelated Bone Marrow Transplantation
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DOI：
10.1016/j.bbmt.2014.01.003
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发表时间：
2014-04-01
影响因子：
4.3
通讯作者：
Mori, Shinichiro
中科院分区：
文献类型：
--
作者：
Kanda, Yoshinobu;Kanda, Junya;Mori, Shinichiro
通过分析日本无关造血干细胞移植受者的移植结局，确定了几种严重急性移植物抗宿主病（GVHD）的高危HLA等位基因错配组合（HR-HLA）。在这项研究中，我们分析了在3个移植时间段的HR-1的影响。我们证实，在早期（1993 - 2001年），HR-MM组III-IV级急性GVHD的发生率显著高于低危（LR）MM组（风险比[HR]，2.74; P < .0001）。然而，在中期（2002年至2007年）和晚期（2008年至2011年），HR-MM和LR-MM组之间III至IV级急性GVHD的发生率差异无统计学意义（分别为HR，1.06; P = 0.85和HR，0.40; P = 0.21）。同样，在早期阶段，HR-MM组的生存率显著劣于LR-MM组（HR，1.46; P =.019），而在中期和晚期阶段，两组之间的生存率差异无统计学意义（分别为HR，1.06; P =.75和HR，.82; P =.58）。总之，随着时间的推移，HR-MM的不良影响已变得不那么显著。在没有匹配的非相关供体或非相关供体存在单个LR-MM的情况下，使用单个HR-MM进行非相关移植可能是可行的选择。（C）2014年美国血液和骨髓移植学会。
Several high-risk HLA allele mismatch combinations (HR-MMs) for severe acute graft-versus-host disease (GVHD) have been identified by analyzing transplantation outcomes in Japanese unrelated hematopoietic stem cell transplant recipients. In this study, we analyzed the effects of HR-MMs in 3 transplantation time periods. We confirmed that the incidence of grade III to IV acute GVHD in the HR-MM group was significantly higher than that in the low-risk (LR) MM group (hazard ratio [HR], 2.74; P < .0001) in the early time period (1993 to 2001). However, the difference in the incidence of grade III to IV acute GVHD between the HR-MM and LR-MM groups was not statistically significant (HR, 1.06; P =.85 and HR,.40; P =.21, respectively) in the mid (2002 to 2007) and late (2008 to 2011) time periods. Similarly, survival in the HR-MM group was significantly inferior to that in the LR-MM group (HR, 1.46; P =.019) in the early time period, whereas the difference in survival between the 2 groups was not statistically significant in the mid and late time periods (HR, 1.06; P =.75 and HR,.82; P =.58, respectively). In conclusion, the adverse impact of HR-MM has become less significant over time. Unrelated transplantation with a single HR-MM could be a viable option in the absence of a matched unrelated donor or an unrelated donor with a single LR-MM. (C) 2014 American Society for Blood and Marrow Transplantation.