Allelic HLA Matching and Pair Origin Are Favorable Prognostic Factors for Unrelated Hematopoietic Stem Cell Transplantation in Neoplastic Hematologic Diseases: An Italian Analysis by the Gruppo Italiano Trapianto di Cellule Staminali e Terapie Cellulari, Italian Bone Marrow Donor Registry, and Associazione Italiana di Immunogenetica e Biologia dei Trapianti.

Autor: Picardi A; Department of Biomedicine and Prevention, Tor Vergata University, Fondazione Policlinico Tor Vergata-Rome Transplant Network, Roma, Italy; Unit of Hematology and HSC Transplant Program, AORN Cardarelli, Napoli, Italy. Electronic address: alessandra.picardi@aocardarelli.it., Sacchi N; Italian Bone Marrow Donor Registry, Ospedale Galliera, Genova, Italy., Miotti V; Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Associazione Italiana di Immunogenetica e Biologia dei Trapianti, Bologna, Italy., Lorentino F; Program in Public Health, Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy., Oldani E; Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy., Rambaldi A; Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; Department of Oncology and Hematology, University of Milan, Milano, Italy., Sessa M; Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale Sant'Anna, Ferrara, Italy., Bruno B; Department of Molecular Biotechnology and Health Sciences, AOU Città della Salute e della Scienza, University of Torino, Torino, Italy; Department of Molecular Biotechnology and Health Sciences, University Hospital Città della Salute e della Scienza, University of Turin, Torino, Italy., Cerno M; Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy., Vago L; Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milano, Italy., Bernasconi P; SC Ematologia Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy., Arcese W; Department of Biomedicine and Prevention, Tor Vergata University, Fondazione Policlinico Tor Vergata-Rome Transplant Network, Roma, Italy., Benedetti F; Department of Medicine, Section of Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy., Pioltelli P; Ospedale San Gerardo, Clinica Ematologica dell'Università Milano-Bicocca, Monza, Italy., Russo D; Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy., Farina L; Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy., Fagioli F; Children's Hospital Regina Margherita, University of Turin, Torino, Italy; University of Turin, Torino, Italy., Guidi S; Università degli Studi di Firenze, Firenze, Italy., Saporiti G; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy., Zallio F; Hematology Department, SS Antonio & Biagio and C. Arrigo Hospital, Alessandria, Italy., Chiusolo P; Diagnostic imaging, oncological radiotherapy and hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy., Borghero C; Local Socio-Health Unit 6- Vicenza, Vicenza, Italy., Papalinetti G; Ospedale Civile, Pescara, Italy., La Rocca U; Hematology Department, University Hospital Policlinico Umberto I, Sapienza University, Roma, Italy., Milone G; Department of Hematology and bone and marrow transplant unit-Azienda Ospedaliera Policlinico di Catania, Catania, Italy., Lamparelli T; Ematologia Ospedale Policlinico San Martino, Genova, Italy., Carella AM; Bone Marrow Transplant Unit, Department of Medical Sciences, Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy., Luppi M; Ematologia - Azienda Ospedaliero Universitaria di Modena, Modena, Italy., Olivieri A; Clinica Di Ematologia Università Politecnica Delle Marche, Ancona, Italy., Martino M; Stem Cell Transplant and Cellular Therapies Unit, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano 'Bianchi-Melacrino-Morelli', Reggio Calabria, Italy., Carluccio P; Hematology and Bone Marrow Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy., Celeghini I; S.C Ematologia, ASO S.Croce e Carle, Cuneo, Italy., Andreani M; Associazione Italiana di Immunogenetica e Biologia dei Trapianti, Bologna, Italy; Transplantation Immunogenetics Laboratory, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy., Gallina AM; Italian Bone Marrow Donor Registry, Ospedale Galliera, Genova, Italy., Patriarca F; Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Department of Medical Area, University of Udine, Udine, Italy., Pollichieni S; Italian Bone Marrow Donor Registry, Ospedale Galliera, Genova, Italy., Mammoliti S; Trials Office, GITMO Gruppo Italiano per il Trapianto di Midollo Osseo, Cellule Staminali Emopoietiche e Terapia Cellulare, Genova, Italy., Miccichè S; Department of Biomedicine and Prevention, Tor Vergata University, Fondazione Policlinico Tor Vergata-Rome Transplant Network, Roma, Italy., Mangione I; Department of Biomedicine and Prevention, Tor Vergata University, Fondazione Policlinico Tor Vergata-Rome Transplant Network, Roma, Italy., Ciceri F; Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milano, Italy., Bonifazi F; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Jazyk: angličtina
Zdroj: Transplantation and cellular therapy [Transplant Cell Ther] 2021 May; Vol. 27 (5), pp. 406.e1-406.e11. Date of Electronic Publication: 2021 Feb 16.
DOI: 10.1016/j.jtct.2020.11.021
Abstrakt: HLA molecules are important for immunoreactivity in allogeneic hematopoietic stem cell transplantation (HSCT). The Gruppo Italiano Trapianto di Cellule Staminali e Terapie Cellulari, Italian Bone Marrow Donor Registry, and Associazione Italiana di Immunogenetica e Biologia dei Trapianti promoted a retrospective observational study to evaluate HLA matching and the impact of allelic HLA mismatching and non-HLA factors on unrelated Italian HSCT outcomes. From 2012 to 2015, 1788 patients were enrolled in the study. The average donor age was 29 years and the average recipient age was 49 years. As a conditioning regimen, 71% of the patients received myeloablative conditioning. For GVHD prophylaxis, 76% received either antithymocyte or anti-T lymphocyte globulin, cyclosporine A, and methotrexate. Peripheral blood was the stem cell source in 80%. The median duration of follow-up was 53 months. Regarding HLA matching, 50% of donor-recipient pairs were 10/10 matched, 38% had 1 mismatch, and 12% had 2 or more mismatches. A total of 302 pairs shared Italian origin. Four-year overall survival (OS), progression-free survival, GVHD-free relapse-free survival, and relapse rates were 49%, 40%, 22%, and 34%, respectively. The 4-year NRM was 27%, and the 100-day cumulative incidence of grade ≥II acute GVHD (aGVHD) was 26%. In multivariate analysis, 9/10 and ≤8/10 HLA allele-matched pairs were associated with worse OS (P = .04 and .007, respectively), NRM (P = .007 and P < .0001, respectively), and grade III-IV aGVHD (P = .0001 and .01, respectively). Moreover, the incidences of grade II-IV aGVHD (P = .001) and chronic GVHD (P = .002) were significantly lower in Italian pairs. In conclusion, 10/10 HLA matching is a favorable prognostic factor for unrelated HSCT outcome in the Italian population. Moreover, the presence of 2 HLA-mismatched loci was associated with a higher NRM (P < .0001) and grade II-IV aGVHD (P = .006) and a poorer OS (P = .001) compared with 1 HLA-mismatched locus in early or intermediate disease phases. Finally, we found that Italian donor and recipient origin is a favorable prognostic factor for GVHD occurrence.
(Copyright © 2020 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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