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: Lucia Farina, Anna Maria Gallina, Paolo Bernasconi, Marco Andreani, Elena Oldani, Mariarosaria Sessa, P Chiusolo, Valeria Miotti, Benedetto Bruno, Francesca Bonifazi, F. Lorentino, Pietro Pioltelli, Mario Luppi, Domenico Russo, Carlo Borghero, Angelo Michele Carella, Attilio Olivieri, Francesco Zallio, William Arcese, Ivana Celeghini, Teresa Lamparelli, G. Papalinetti, Fabio Benedetti, Giuseppe Milone, Stefano Guidi, Alessandro Rambaldi, Sonia Mammoliti, Ursula La Rocca, Franca Fagioli, Simona Pollichieni, Alessandra Picardi, Fabio Ciceri, Luca Vago, Massimo Martino, Ilaria Mangione, Francesca Patriarca, Paola Carluccio, Michela Cerno, Nicoletta Sacchi, Silvia Miccichè, Giorgia Saporiti
Přispěvatelé: Picardi, A., Sacchi, N., Miotti, V., Lorentino, F., Oldani, E., Rambaldi, A., Sessa, M., Bruno, B., Cerno, M., Vago, L., Bernasconi, P., Arcese, W., Benedetti, F., Pioltelli, P., Russo, D., Farina, L., Fagioli, F., Guidi, S., Saporiti, G., Zallio, F., Chiusolo, P., Borghero, C., Papalinetti, G., La Rocca, U., Milone, G., Lamparelli, T., Carella, A. M., Luppi, M., Olivieri, A., Martino, M., Carluccio, P., Celeghini, I., Andreani, M., Gallina, A. M., Patriarca, F., Pollichieni, S., Mammoliti, S., Micciche, S., Mangione, I., Ciceri, F., Bonifazi, F.
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Popis: 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.
Databáze: OpenAIRE
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