Wang Yuyao, Xu Shixia, Fang Pu
The First Clinical Medical College of Nanchang University, Nanchang, Jiangxi, China.
Department of Medical Information, the Sixth Medical Center of PLA General Hospital, Beijing, China.
Transplant Proc. 2019 Jul-Aug;51(6):1982-1989. doi: 10.1016/j.transproceed.2019.04.053.
Human leukocyte antigen match is the most important donor factor affecting transplant outcome. The HLA-DPB1 mismatch on the clinical outcome of hematopoietic stem cell transplant (HSCT) is less clear. This study is the first meta-analysis to investigate the impact of HLA-DPB1 loci mismatch on clinical outcome after unrelated donor HSCT for hematologic malignant disease.
We electronically searched the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and a related database (January 1995-December 2018) for all relevant articles. Comparative studies were carried out to investigate the impact of HLA-DPB1 loci mismatch on clinical outcome after unrelated donor HSCT, that is, the disease-free survival, engraftment, graft-vs-host disease, relapse, and transplant-related mortality (TRM). We performed a meta-analysis using Review Manager 5.3.5 software and adopted funnel plot regression to assess the publication bias.
A total of 1570 articles were retrieved; 21 studies including 27,852 patients were assessed. Pooled comparisons of studies found that the HLA-DPB1-mismatched group had a lower rate of disease-free survival than the DPB1-matched group and lower overall survival in non-T cell-depleted transplant than the DPB1-matched group. The DPB1-mismatched group has higher incidence of acute graft-vs-host disease (aGVHD) and severe (≥ III degree) aGVHD, lower relapse rate, and higher TRM. Moreover, compared with 1-antigen mismatch, 2-antigen mismatch in DPB1 had a higher risk of TRM and a lower relapse rate, and the nonpermissive DPB1 mismatch had significantly higher rate of severe aGvHD and lower rate of disease relapse.
This analysis confirmed that HLA-DPB1 has important influence on survival and transplant-related complications during unrelated donor HSCT, and HLA-DPB1 donor selection strategies have been proposed based on personalized algorithm.
人类白细胞抗原匹配是影响移植结局的最重要供体因素。HLA-DPB1错配对造血干细胞移植（HSCT）临床结局的影响尚不清楚。本研究是第一项meta分析，旨在探讨HLA-DPB1基因座错配对血液系统恶性疾病无关供体HSCT后临床结局的影响。
我们通过电子检索PubMed、EMBASE、Cochrane对照试验中央登记库及相关数据库（1995年1月至2018年12月），查找所有相关文章。进行比较研究，以探讨HLA-DPB1基因座错配对无关供体HSCT后临床结局的影响，即无病生存率、植入、移植物抗宿主病、复发及移植相关死亡率（TRM）。我们使用Review Manager 5.3.5软件进行meta分析，并采用漏斗图回归评估发表偏倚。
共检索到1570篇文章；评估了21项研究，共27852例患者。研究的汇总比较发现，HLA-DPB1错配组的无病生存率低于DPB1匹配组，在非T细胞去除移植中，其总生存率低于DPB1匹配组。DPB1错配组急性移植物抗宿主病（aGVHD）和重度（≥Ⅲ度）aGVHD的发生率较高，复发率较低，TRM较高。此外，与1抗原错配相比，DPB1的2抗原错配TRM风险更高，复发率更低，非允许性DPB1错配的重度aGvHD发生率显著更高，疾病复发率更低。
本分析证实HLA-DPB1对无关供体HSCT期间的生存及移植相关并发症有重要影响，并基于个性化算法提出了HLA-DPB1供体选择策略。
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