Brunstein Claudio, Zhang Mei-Jie, Barker Juliet, St Martin Andrew, Bashey Asad, de Lima Marcos, Dehn Jason, Hematti Peiman, Perales Miguel-Angel, Rocha Vanderson, Territo Mary, Weisdorf Daniel, Eapen Mary
University of Minnesota Medical Center, Minneapolis, MN, USA.
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Haematologica. 2017 May;102(5):941-947. doi: 10.3324/haematol.2016.158584. Epub 2017 Jan 25.
The effects of inter-unit HLA-match on early outcomes with regards to double cord blood transplantation have not been established. Therefore, we studied the effect of inter-unit HLA-mismatching on the outcomes of 449 patients with acute leukemia after double cord blood transplantation. Patients were divided into two groups: one group that included transplantations with inter-unit mismatch at 2 or less HLA-loci (n=381) and the other group with inter-unit mismatch at 3 or 4 HLA-loci (n=68). HLA-match considered low resolution matching at HLA-A and -B loci and allele-level at HLA-DRB1, the accepted standard for selecting units for double cord blood transplants. Patients', disease, and transplant characteristics were similar in the two groups. We observed no effect of the degree of inter-unit HLA-mismatch on neutrophil (Hazard Ratio 1.27, =0.11) or platelet (Hazard Ratio 0.1.13, =0.42) recovery, acute graft--host disease (Hazard Ratio 1.17, =0.36), treatment-related mortality (Hazard Ratio 0.92, =0.75), relapse (Hazard Ratio 1.18, =0.49), treatment failure (Hazard Ratio 0.99, =0.98), or overall survival (Hazard Ratio 0.98, =0.91). There were no differences in the proportion of transplants with engraftment of both units by three months (5% after transplantation of units with inter-unit mismatch at ≤2 HLA-loci and 4% after transplantation of units with inter-unit mismatch at 3 or 4 HLA-loci). Our observations support the elimination of inter-unit HLA-mismatch criterion when selecting cord blood units in favor of optimizing selection based on individual unit characteristics.
单位间人类白细胞抗原（HLA）匹配对双份脐血移植早期结局的影响尚未明确。因此，我们研究了单位间HLA错配情况对449例急性白血病患者双份脐血移植结局的影响。患者被分为两组：一组为单位间HLA错配在2个或以下HLA位点的移植（n = 381），另一组为单位间HLA错配在3个或4个HLA位点的移植（n = 68）。HLA匹配是指HLA - A和 - B位点的低分辨率匹配以及HLA - DRB1的等位基因水平匹配，这是选择双份脐血移植单位的公认标准。两组患者的疾病和移植特征相似。我们观察到单位间HLA错配程度对中性粒细胞恢复（风险比1.27，P = 0.11）、血小板恢复（风险比1.13，P = 0.42）、急性移植物抗宿主病（风险比1.17，P = 0.36）、治疗相关死亡率（风险比0.92，P = 0.75）、复发（风险比1.18，P = 0.49）、治疗失败（风险比0.99，P = 0.98）或总生存期（风险比0.98，P = 0.91）均无影响。移植后三个月内两份脐血均植入的移植比例在两组间无差异（单位间错配≤2个HLA位点的移植后为5%，单位间错配3个或4个HLA位点的移植后为4%）。我们的观察结果支持在选择脐血单位时取消单位间HLA错配标准，转而支持基于单个单位特征进行优化选择。
