Outcomes of Patients with Myeloid Malignancies Treated with Allogeneic Hematopoietic Stem Cell Transplantation from Matched Unrelated Donors Compared with One Human Leukocyte Antigen Mismatched Related Donors Using HLA Typing at 10 Loci

• Published in: Biology of blood and marrow transplantation Vol. 17; no. 6; pp. 923 - 929
• Main Authors: Ciurea, Stefan O, Saliba, Rima M, Rondon, Gabriela, Patah, Poliana A, Aung, Fleur, Cano, Pedro, Andersson, Borje S, Kebriaei, Partow, Popat, Uday, Fernandez-Vina, Marcelo, Champlin, Richard E, de Lima, Marcos
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2011
• Subjects: 9/10 matched related donors; Alleles; Blood Donors; Class I HLA mismatch; Class II HLA mismatch; Female; Graft Rejection - immunology; Graft Rejection - prevention & control; Graft vs Host Disease - genetics; Graft vs Host Disease - immunology; Graft vs Host Disease - mortality; Graft vs Host Disease - pathology; Hematology, Oncology and Palliative Medicine; Hematopoietic Stem Cell Transplantation; Histocompatibility; Histocompatibility Testing - methods; HLA Antigens - genetics; HLA Antigens - immunology; HLA matched unrelated donors; Humans; Leukemia, Myeloid - genetics; Leukemia, Myeloid - immunology; Leukemia, Myeloid - mortality; Leukemia, Myeloid - pathology; Leukemia, Myeloid - therapy; Male; Middle Aged; Retrospective Studies; Risk Factors; Survival Analysis; Transplantation; Transplantation, Homologous; Treatment Outcome; HLA matched unrelated donors; Class II HLA mismatch; 9/10 matched related donors; Class I HLA mismatch; Hematopoietic stem cell transplantation
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2010.10.017

Most candidates for hematopoietic stem cell transplantation (HSCT) lack a human leukocyte antigen (HLA)-identical sibling donor. Some patients may have a related donor with whom they are mismatched at 1 antigen/allele. It is not known whether such a match is preferable to a matched unrelated donor (MUD). We evaluated the outcomes (survival, relapse, nonrelapse mortality [NRM]) of all 28 patients with a single HLA antigen/allele mismatch identified through high-resolution HLA typing at HLA-A, -B, -C, -DRB1, and -DQB1, and all 318 patients with myeloid malignancies who received transplants from a 10/10 MUD treated during the same period of time at a single institution. Overall, outcomes for patients treated from a 1-antigen/allele mismatch related donor were significantly worse than from a MUD, primarily because of increased NRM. Overall survival (OS) rates at 3 years for 1-antigen/allele mismatched related donor and MUD transplant recipients were 19% and 45% ( P = .007), and NRM rates were 40% and 26% ( P = .05), respectively. Patients with class I mismatches appeared to have poorer OS than did patients with class II mismatches. A higher incidence of graft rejection was identified in the mismatched related donor group ( P = .02). These results indicate that transplant outcomes are better with a MUD than with a 1 antigen/allele-mismatched related donor.