Impact of the Direction of HLA Mismatch on Transplantation Outcomes in Single Unrelated Cord Blood Transplantation
Impact of the Direction of HLA Mismatch on Transplantation Outcomes in Single Unrelated Cord Blood Transplantation
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DOI：
10.1016/j.bbmt.2012.09.017
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发表时间：
2013-02-01
影响因子：
4.3
通讯作者：
Kanda, Yoshinobu
中科院分区：
文献类型：
--
作者：
Kanda, Junya;Atsuta, Yoshiko;Kanda, Yoshinobu
HLA错配（MM）的方向对无关脐血（UCB）移植结果的影响尚未明确。我们对2977例因白血病或骨髓增生异常综合征接受单次脐带血移植的患者进行了一项回顾性研究。通过HLA-A、-B和-DR位点的血清学数据评估HLA配型。移植时受体的中位年龄为41岁（范围，0-82岁），2300名受体（77%）年龄>= 16岁。2年总生存率为0.46。与1例双向MM相比，仅在移植物抗宿主方向或仅在宿主抗移植物方向存在MM与总体死亡率无关（风险比[HR]，0.88; P = 0.317和HR，0.95; P = 0.670）。这一结果在儿童和成人队列中一致。仅在移植物抗宿主方向存在MM与较低的非复发死亡率相关（HR，0.65; P = 0.040），仅在儿童队列中具有显著性。没有MM类别与复发相关。我们的研究结果表明，HLA-MM的方向对脐血移植后的总生存率没有显著影响。(C)2013年美国血液和骨髓移植协会。
The impact of the direction of HLA mismatch (MM) on outcome in unrelated cord blood (UCB) transplantation has not yet been clarified. We conducted a retrospective study using national registry data on 2977 patients who underwent transplantation using a single UCB for leukemia or myelodysplastic syndrome. HLA matching was assessed by serologic data for HLA-A, -B, and -DR loci. The median age of the recipients at transplantation was 41 years (range, 0-82 years), and 2300 recipients (77%) were age >= 16 years. The 2-year overall survival rate was 0.46. The presence of MM only in the graft-versus-host direction or only in the host-versus-graft direction was not associated with overall mortality (hazard ratio [HR], 0.88; P = .317 and HR, 0.95; P = .670, respectively) compared with 1 bidirectional MM. This finding was consistent in both the child and adult cohorts. The presence of MM only in the graft-versus-host direction was associated with a lower incidence of nonrelapse mortality (HR, 0.65; P = .040), significant only in the child cohort. No MM category was associated with relapse. Our findings suggest that the direction of HLA MM does not have a significant impact on overall survival after UCB transplantation. (C) 2013 American Society for Blood and Marrow Transplantation.