HLA Association with Hematopoietic Stem Cell Transplantation Outcome: The Number of Mismatches at HLA-A, -B, -C, -DRB1, or -DQB1 Is Strongly Associated with Overall Survival
| Autor: | Valérie Dubois, Evelyne Marry, A. Dormoy, Virginia Lepage, Monique Bois, Marc Busson, Pascale Perrier, Jean-Pierre Jouet, Pascale Loiseau, L. Gebuhrer, Marie-Lorraine Balere, Denis Reviron, Didier Blaise, Dominique Masson, Ryad Tamouza, Dominique Charron, Agnès Moine, Katia Gagne, Jean-Denis Bignon, Colette Raffoux, Antoine Toubert, L. Absi, Zina Chir, Isabelle Jollet |
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| Rok vydání: | 2007 |
| Předmět: |
Adult
Male Oncology medicine.medical_specialty Adolescent Bone marrow transplantation Survival medicine.medical_treatment GVHD Graft vs Host Disease Histocompatibility Testing Human leukocyte antigen Hematopoietic stem cell transplantation Risk Assessment Cohort Studies HLA Antigens Recurrence immune system diseases Internal medicine medicine Humans Relapse Child Survival analysis Proportional Hazards Models Retrospective Studies Transplantation Proportional hazards model business.industry Hazard ratio Hematopoietic Stem Cell Transplantation Infant Hematology Middle Aged Survival Analysis Confidence interval HLA-A KIR HLA Child Preschool Immunology Female business |
| Zdroj: | Biology of Blood and Marrow Transplantation. 13(8):965-974 |
| ISSN: | 1083-8791 |
| DOI: | 10.1016/j.bbmt.2007.04.010 |
| Popis: | HLA matching between the donor and recipient improves the success of unrelated hematopoietic stem cell transplantation (HSCT). Because many patients in need of an unrelated transplant have only donors with mismatch, information is needed to evaluate the limits of HLA mismatching. We examined the association of survival, acute graft-versus-host disease (aGVHD) and relapse with HLA-A, -B, -C, -DRB, -DQB1, and -DPB1 mismatching in 334 patients coming from 12 French transplant centers and who received a non-T cell-depleted bone marrow graft from an unrelated donor. All patients were prepared with the use of myeloablative conditioning regimens. Our analyses demonstrate negative effects of HLA mismatching for either HLA-A, -B, -C, -DRB1, or -DQB1 loci on survival. Multivariate Cox analyses showed that a single mismatch was associated with a significant decrement in survival (P = .046, hazard ratio [HR] = 1.41, confidence interval [CI] 95% 1.1-1.98). The presence of multiple mismatches was worse for survival (P = .003, HR = 1.91, CI 95% 1.26-2.91) and severe aGVHD (grade III-IV) (P = .002, HR = 2.51, CI95% 1.41-4.46). The cumulative incidences of aGVHD and relapse in those HLA-A, -B, -C, -DRB1, and -DQB1 identical pairs with 2, 1, or 0 DPB1 incompatibilities were 63%, 50%, and 51%, and 12%, 27%, and 20%, respectively, but these differences were not statistically significant. Similar differences of aGVHD and relapse, but not statistically significant, were observed in those HLA-A, -B, -C, -DRB1, and -DQB1 identical pairs with DPB1 disparities classified into permissive or nonpermissive mismatches according to Zino’s classification based on a hierarchy of the immunogenicity of the HLA-DP molecules. “Missing killer cell immunoglobulin-like receptor (KIR) ligand” evaluated on the presence of HLA-C1, -C2, and Bw4 groups in the recipients was not associated with aGVHD, survival, and relapse in this cohort of non-T cell-depleted HSCT. |
| Databáze: | OpenAIRE |
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