Impact of human leukocyte antigen mismatch on outcomes after unrelated bone marrow transplantation in paediatric patients: A retrospective analysis by the JSTCT HLA working group.
Impact of human leukocyte antigen mismatch on outcomes after unrelated bone marrow transplantation in paediatric patients: A retrospective analysis by the JSTCT HLA working group.
复制标题
人类白细胞抗原不匹配对儿科患者无关骨髓移植后结果的影响：JSTCT HLA 工作组的回顾性分析。
DOI：
10.1111/bjh.18425
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Kanda J.
中科院分区：
文献类型：
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作者：
Kato I;Sakaguchi H;Kato S;Sato M;Noguchi M;Yoshida N;Koh K;Koike T;Yanagimachi M;Kato K;Takahashi Y;Fujita N;Sato A;Hashii Y;Tabuchi K;Atsuta Y;Morishima S;Kanda J.
尚未充分研究患有血液系统恶性肿瘤的儿童患者在无关骨髓移植后，人类白细胞抗原（HLA）在HLA-A、-B、-C和-DRB 1位点错配的影响。在这里，我们分析了1993年至2017年期间在日本接受首次无关骨髓移植的血液学恶性肿瘤患者（所有年龄≤15岁;n= 1330）。结果表明，尽管HLA错配与低复发率显著相关，但它也与较高的非复发死亡率相关。HLA错配与低总生存率之间存在显著相关性。基因座错配分析显示，与成人一样，HLA-C错配对生存率有显著的负面影响;然而，在儿科患者中，HLA-DRB 1错配没有负面影响，尽管这些HLA错配效应在最近的病例中减弱。综上所述，结果表明，HLA匹配的供体应该是儿科患者的第一候选人;然而，对于没有匹配的兄弟姐妹或匹配的无关供体的患者，我们可以选择HLA-DRB 1不匹配的无关供体（如果可用）。
The impact of human leukocyte antigen (HLA) mismatching at the HLA‐A, ‐B, ‐C, and ‐DRB1 loci after unrelated bone marrow transplantation in paediatric patients with haematological malignancies has not been fully examined. Here, we analysed patients with haematological malignancies (all aged ≤15 years;n= 1330) who underwent a first unrelated bone marrow transplantation between 1993 and 2017 in Japan. The results show that although an HLA mismatch was significantly associated with a low relapse rate, it was also associated with higher non‐relapse mortality. There was a significant association between HLA mismatch and low overall survival. Locus mismatch analysis revealed that, as in adults, an HLA‐C mismatch had a significant negative impact on survival; however, in paediatric patients, an HLA‐DRB1 mismatch did not have a negative impact, although these HLA mismatch effects are weakened in recent cases. Taken together, the results suggest that an HLA‐matched donor should be the first candidate for paediatric patients; however, for patients without a matched sibling or matched unrelated donor, we can select an unrelated donor with a mismatch at HLA‐DRB1 if available.