Impact of allele-level HLA matching on outcomes after myeloablative single unit umbilical cord blood transplantation for hematologic malignancy
Impact of allele-level HLA matching on outcomes after myeloablative single unit umbilical cord blood transplantation for hematologic malignancy
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DOI：
10.1182/blood-2013-05-506253
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发表时间：
2014-01-02
期刊：
影响因子：
20.3
通讯作者：
Rocha, Vanderson
中科院分区：
文献类型：
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作者：
Eapen, Mary;Klein, John P.;Rocha, Vanderson
我们研究了人类白细胞抗原(HLA)-A、-B、-C和-DRB1等位基因水平匹配在1568例血液恶性肿瘤单脐带血（UCB）移植中的作用。主要终点为非复发死亡率（NRM）。只有7%的单位在HLA-A、-B、-C和-DRB1等位基因匹配；1等位基因错配率为15%，2等位基因错配率为26%，3等位基因错配率为30%，4等位基因错配率为16%，5等位基因错配率为5%。在一个子集中，使用代入分配等位基因水平的HLA匹配；在实际和估算的hla匹配组之间，证实了hla匹配分配与结果相关性之间的一致性。与hla匹配的单位相比，在3、4或5个等位基因不匹配时，中性粒细胞恢复较低，但1或2个等位基因不匹配。与hla匹配的单位相比，在1、2、3、4或5个等位基因错配的单位的NRM更高。观察到的效果与细胞剂量和患者年龄无关。这些数据支持在单个UCB单位的选择中等位基因水平的HLA匹配。
We studied the effect of allele-level matching at human leukocyte antigen (HLA)-A, -B, -C, and -DRB1 in 1568 single umbilical cord blood (UCB) transplantations for hematologic malignancy. The primary end point was nonrelapse mortality (NRM). Only 7% of units were allele matched at HLA-A, -B, -C, and -DRB1; 15% were mismatched at 1, 26% at 2, 30% at 3, 16% at 4, and 5% at 5 alleles. In a subset, allele-level HLA match was assigned using imputation; concordance between HLA-match assignment and outcome correlation was confirmed between the actual and imputed HLA-match groups. Compared with HLA-matched units, neutrophil recovery was lower with mismatches at 3, 4, or 5, but not 1 or 2 alleles. NRM was higher with units mismatched at 1, 2, 3, 4, or 5 alleles compared with HLA-matched units. The observed effects are independent of cell dose and patient age. These data support allele-level HLA matching in the selection of single UCB units.