Impact of HLA-DPB1 Matching on Clinical Outcomes after Haploidentical-Related Hematopoietic Stem Cell Transplantation
| Autor: | Olga G. Cantú-Rodríguez, José Carlos Jaime-Pérez, David Gómez-Almaguer, Rosario Salazar-Riojas, César Homero Gutiérrez-Aguirre, Nereida Méndez-Ramírez, Carlos O. Cancela-Murrieta, Patrizia Aguilar-Calderón, Lorena Salazar-Cavazos |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Statistical difference Hematopoietic stem cell transplantation Donor Selection Young Adult Overall survival Humans Medicine University medical Child HLA-DP beta-Chains Retrospective Studies Gynecology HLA-DPB1 business.industry Patient Selection Hematopoietic Stem Cell Transplantation Infant General Medicine Middle Aged Hematologic Diseases Survival Rate Transplantation Treatment Outcome Child Preschool Transplantation Haploidentical Female business Clinical record |
| Zdroj: | Revista de investigaci�n Cl�nica. 72 |
| ISSN: | 0034-8376 |
| Popis: | espanolAntecedentes: No se ha establecido el impacto de la compatibilidad de HLA-DPB1 y su papel como antigeno de trasplante en el trasplante de celulas madre hematopoyeticas relacionadas con haploidenticas (haplo-R-HSCT) y se ha sugerido un efecto negativo sobre la supervivencia. Objetivo: El objetivo de la determinacion fue estudiar la frecuencia y los efectos clinicos de la incompatibilidad en el locus HLA-DPB1 en el contexto del haplo-R-HSCT. Metodos: Se revisaron las historias clinicas y archivos electronicos de 91 pacientes con una enfermedad hematologica que fueron sometidos a haplo-TPH desde enero de 2009 a octubre de 2017 en un centro medico universitario. La supervivencia global (SG) se estimo mediante el metodo de Kaplan-Meier; Se determino la incidencia acumulada de mortalidad relacionada con el trasplante (TRM) y las tasas de recaida. La enfermedad de injerto contra huesped aguda se evaluo mediante regresion logistica binaria. Se utilizo el modelo de regresion de Cox con un intervalo de confianza del 95% para examinar la asociacion entre las diferentes variables y su efecto sobre la SG. Resultados: De los 91 pares de donante-receptor, 24 (26,37%) compartian la identidad DPB1 completa, 60 (65,93%) tenian un desajuste en un alelo y 7 (7,70%) tenian un desajuste en dos alelos. Se encontraron veinticuatro alelos diferentes de HLA-DPB1; los mas frecuentes fueron DPB1 * 04: 01 (34,1%) y DPB1 * 04: 02 (27,5%). SG a dos anos, la incidencia acumulada de TRM y recaida fue 51,3 ± 6,8%, 28 ± 6% y 60 ± 7,8% para todos los trasplantes relacionados con haplo, respectivamente, sin diferencia estadistica entre los pacientes compatibles con HLA-DPB1 y los pacientes parcialmente compatibles. En el analisis de regresion de Cox, no se identificaron factores de riesgo asociados con SG, TRM o recaidas. Conclusion: el desajuste de HLA-DPB1 en el entorno del haplo-R-HSCT no influyo en los resultados del trasplante y fue clinicamente tolerable. Se encontro un alto grado de homocigosidad. EnglishBackground: The impact of HLA-DPB1 compatibility and its role as a transplantation antigen in haploidentical-related hema- topoietic stem cell transplant (haplo-R-HSCT) have not been established, and a negative effect on survival has been sug- gested. Objective: The objective of the determine was to study the frequency and clinical effects of incompatibility at the HLA-DPB1 locus in the haplo-R-HSCT setting. Methods: Clinical records and electronic files of 91 patients with a hemato- logical disease who underwent haplo-HSCT from January 2009 to October 2017 in a university medical center were scrutinized. Overall survival (OS) was estimated by the Kaplan–Meier method; the cumulative incidence of transplant-related mortality (TRM) and relapse rates was determined. Acute graft-versus-host disease was assessed by binary logistic regression. Cox regression model with a 95% confidence interval was used to examine the association between the different variables and their effect on OS. Results: Of the 91 donor-recipient pairs, 24 (26.37%) shared complete DPB1 identity, 60 (65.93%) had a mismatch at one allele, and 7 (7.70%) were mismatched at two alleles. Twenty-four different HLA-DPB1 alleles were found; the most frequent were DPB1*04:01 (34.1%) and DPB1*04:02 (27.5%). Two-year OS, the cumulative incidence of TRM and relapse was 51.3 ± 6.8%, 28 ± 6% and 60 ± 7.8% for all haplo-related transplants, respectively, with no statistical difference between HLA-DPB1 matched and partially matched patients. In Cox regression analysis, no risk factors associated with OS, TRM, or relapses were identified. Conclusion: HLA-DPB1 mismatching in the haplo-R-HSCT setting did not influence transplant outcomes and was clinically tolerable. A high degree of homozygosity was found. (REV INVEST CLIN. 2020;72(2):69-79) |
| Databáze: | OpenAIRE |
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