Journal
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
Volume 16, Issue 4, Pages 482-489Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2009.11.011
Keywords
Nonmyeloablative conditioning; Allogeneic blood or marrow transplantation; Graft-versus-host disease; Human leukocyte antigen; Cyclophosphamide
Categories
Funding
- National Institutes of Health [P01 CA015396, K23 CA124465]
- Leukemia and Lymphoma Society of America
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Although some reports have found an association between increasing HLA disparity between donor and recipient and fewer relapses after allogeneic blood or marrow transplantation (BMT), this potential benefit has been offset by more graft-versus-host disease (GVHD) and nonrelapse mortality (NRM). However, the type of GVHD prophylaxis might influence the balance between GVHD toxicity and relapse. The present study analyzed the impact of greater HLA disparity on outcomes of a specific platform for nonmyeloablative (NMA), HLA-haploidentical transplantation. A retrospective analysis was performed of 185 patients with hematologic malignancies enrolled in 3 similar trials of NMA, related donor, haploidentical BMT incorporating high-dose posttransplantation cyclophosphamide for GVHD prophylaxis. No significant association was found between the number of HLA mismatches (HLA-A, -B, -Cw, and -DRBI combined) and risk of acute grade II-IV GVHD (hazard ratio [HR] = 0.89; P = .68 for 3-4 vs fewer antigen mismatches). More mismatching also had no detrimental effect on event-free survival (on multivariate analysis, HR = 0.60, P = .03 for 3-4 vs fewer antigen mismatches and HR = 0.55, P = .03 for 3-4 vs fewer allele mismatches). Thus, greater HLA disparity does not appear to worsen overall outcome after NMA haploidentical BMT with high-dose posttransplantation cyclophosphamide. Biol Blood Marrow Transplant 16: 482-489 (2010) (C) 2010 American Society for Blood Marrow Transplantation
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