Allele-level HLA matching for umbilical cord blood transplantation for non-malignant diseases in children: a retrospective analysis
| Autor: | Vanderson Rocha, Robert Wynn, Annalisa Paviglianiti, Michael R. Veneris, Mary Eapen, Joanne Kurtzberg, Chantal Kenzey, Mary M. Horowitz, Katharina Fleischhauer, Stella M. Davies, Eliane Gluckman, Fernanda Volt, Stephen R. Spellman, Jean Hugues Dalle, Jaap Jan Boelens, Andrew St. Martin, Andrew J. Cant, Tao Wang, Annalisa Ruggeri, Stephanie J. Lee, Carmem Sales Bonfim, John Freeman, Katherine C. Hsu, Paul Veys, Gérard Michel, Paul J. Orchard, Colleen Brady |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Medizin Human leukocyte antigen Umbilical cord 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Child Alleles Survival analysis Retrospective Studies Hematology Umbilical Cord Blood Transplantation business.industry Histocompatibility Testing Hazard ratio Infant Retrospective cohort study Fetal Blood Survival Analysis Surgery Transplantation Treatment Outcome medicine.anatomical_structure Child Preschool 030220 oncology & carcinogenesis Female business 030215 immunology |
| Zdroj: | The Lancet Haematology. 4:e325-e333 |
| ISSN: | 2352-3026 |
| Popis: | The standard for selecting unrelated umbilical cord blood units for transplantation for non-malignant diseases relies on antigen-level (lower resolution) HLA typing for HLA-A and HLA-B, and allele-level for HLA-DRB1. We aimed to study the effects of allele-level matching at a higher resolution-HLA-A, HLA-B, HLA-C, and HLA-DRB1, which is the standard used for adult unrelated volunteer donor transplantation for non-malignant diseases-for umbilical cord blood transplantation.We retrospectively studied 1199 paediatric donor-recipient pairs with allele-level HLA matching who received a single unit umbilical cord blood transplantation for non-malignant diseases reported to the Center for International Blood and Marrow Transplant Research or Eurocord and European Group for Blood and Marrow Transplant. Transplantations occurred between Jan 1, 2000, and Dec 31, 2012. The primary outcome was overall survival. The effect of HLA matching on survival was studied using a Cox regression model.Compared with HLA-matched transplantations, mortality was higher with transplantations mismatched at two (hazard ratio [HR] 1·55, 95% CI 1·08-2·21, p=0·018), three (2·04, 1·44-2·89, p=0·0001), and four or more alleles (3·15, 2·16-4·58, p0·0001). There were no significant differences in mortality between transplantations that were matched and mismatched at one allele (HR 1·18, 95% CI 0·80-1·72, p=0·39). Other factors associated with higher mortality included recipient cytomegalovirus seropositivity (HR 1·40, 95% CI 1·13-1·74, p=0·0020), reduced intensity compared with myeloablative conditioning regimens (HR 1·36, 1·10-1·68, p=0·0041), transplantation of units with total nucleated cell dose of more than 21 × 10These data support a change from current practice in that selection of unrelated umbilical cord blood units for transplantation for non-malignant diseases should consider allele-level HLA matching at HLA-A, HLA-B, HLA-C, and HLA-DRB1.National Cancer Institute; National Heart, Lung, and Blood Institute; National Institute for Allergy and Infectious Diseases; US Department of Health and Human Services-Health Resources and Services Administration; and US Department of Navy. |
| Databáze: | OpenAIRE |
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