Nonmyeloablative HLA-haploidentical bone marrow transplantation with high-dose posttransplantation cyclophosphamide: effect of HLA disparity on outcome.
Nonmyeloablative HLA-haploidentical bone marrow transplantation with high-dose posttransplantation cyclophosphamide: effect of HLA disparity on outcome.
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DOI：
10.1016/j.bbmt.2009.11.011
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发表时间：
2010-04
期刊：
影响因子：
--
通讯作者：
Fuchs EJ
中科院分区：
文献类型：
--
作者：
Kasamon YL;Luznik L;Leffell MS;Kowalski J;Tsai HL;Bolaños-Meade J;Morris LE;Crilley PA;O'Donnell PV;Rossiter N;Huff CA;Brodsky RA;Matsui WH;Swinnen LJ;Borrello I;Powell JD;Ambinder RF;Jones RJ;Fuchs EJ
尽管一些报告发现，在同种异体血液或骨髓移植后，供体和受体之间的HLA差异增加了，但这种潜在的益处已被更多的移植物抗宿主病（GVHD）和非逆性死亡率所抵消。 GVHD预防的类型可能会影响GVHD毒性和缓解之间的平衡。对于非甲状腺素，HLA - 单倍型移植。 HLA不匹配（HLA -A，-B，-CW和-DRB1组合）和急性等级的风险II – IV GVHD（危险比.89，p = 0.68，3-4与较少的抗原不匹配）。对于3-4个抗原不匹配的危险比.55，p = .03的3-4与等位基因不匹配的比例更少。单倍型BMT具有高剂量的移植后环磷酰胺。
Although some reports have found increasing HLA disparity between donor and recipient to be associated with fewer relapses after allogeneic blood or marrow transplantation (BMT), this potential benefit has been offset by more graft-versus-host disease (GVHD) and nonrelapse mortality. However, the type of GVHD prophylaxis could influence the balance between GVHD toxicity and relapse. We analyzed the impact of greater HLA disparity on outcomes of a specific platform for nonmyeloablative, HLA-haploidentical transplantation. A retrospective analysis was performed on 185 patients with hematologic malignancies enrolled on three similar trials of nonmyeloablative, related donor, haploidentical BMT incorporating high-dose posttransplantation cyclophosphamide for GVHD prophylaxis. No significant association was found between the number of HLA mismatches (HLA-A, -B, -Cw, and -DRB1 combined) and risk of acute grade II–IV GVHD (hazard ratio .89, P = .68 for 3–4 versus fewer antigen mismatches). More mismatching also had no detrimental effect on event-free survival (on multivariate analysis, hazard ratio .60, P = .03 for 3–4 versus fewer antigen mismatches; hazard ratio .55, P = .03 for 3–4 versus fewer allele mismatches). Thus, greater HLA disparity does not appear to worsen overall outcomes after nonmyeloablative haploidentical BMT with high-dose posttransplantation cyclophosphamide.
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影响因子：
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作者：
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