Effect of donor-recipient HLA matching at HLA A, B, C, and DRB1 on outcomes after umbilical-cord blood transplantation for leukemia and myelodysplastic syndrome: A retrospective analysis
The Lancet Oncology - Online First, 10/07/2011
Clinical Article
Eapen M et al. – These data suggest that the present strategy for umbilical-cord blood unit selection should be reassessed; matching at HLA C for units that are matched at HLA A, B, or DRB1 or in the presence of a single locus mismatch at HLA A, B, or DRB1 should be included to minimise mortality risks.
Methods- Used Cox regression to assess retrospectively effect of donor—recipient HLA matching on outcomes of single umbilical-cord blood transplantations for leukaemia and myelodysplastic syndrome
- Primary endpoint was transplant-related mortality
- HLA typing was done with molecular techniques with minimum of intermediate resolution for HLA A, B, and C, and at allele-level for DRB1
- Median age of our study population was 10 years (range <1—62) and 552 (69%) of 803 patients were aged 16 years or younger at transplantation
- Compared with transplantations matched at HLA A, B, C, and DRB1 (n=69), transplant-related mortality risk was higher after transplantations matched at HLA A, B, and DRB1 and mismatched at HLA C (n=23; HR 3·97, 95% CI 1·27—12·40; p=0·018)
- Transplant-related mortality risk was also higher after transplantations with single mismatch at HLA A, B, or DRB1 and mismatched at HLA C (n=234; 1·70, 1·06—2·74; p=0·029) compared with transplantations matched at HLA C with single mismatch at HLA A, B, or DRB1 (n=127)
- Assessing overall effect of HLA disparity on transplant-related mortality, risks were higher with units mismatched at 2 (n=259; 3·27, 1·42—7·54; p=0·006), 3 (n=253; 3·34, 1·45—7·71; p=0·005), or 4 (n=75; 3·51, 1·44—8·58; p=0·006) loci compared with matched units (n=69)
