TY - JOUR
T1 - Nonmyeloablative HLA-Haploidentical Bone Marrow Transplantation with High-Dose Posttransplantation Cyclophosphamide
T2 - Effect of HLA Disparity on Outcome
AU - Kasamon, Yvette L.
AU - Luznik, Leo
AU - Leffell, Mary S.
AU - Kowalski, Jeanne
AU - Tsai, Hua Ling
AU - Bolaños-Meade, Javier
AU - Morris, Lawrence E.
AU - Crilley, Pamela A.
AU - O'Donnell, Paul V.
AU - Rossiter, Nancy
AU - Huff, Carol Ann
AU - Brodsky, Robert A.
AU - Matsui, William H.
AU - Swinnen, Lode J.
AU - Borrello, Ivan
AU - Powell, Jonathan D.
AU - Ambinder, Richard F.
AU - Jones, Richard J.
AU - Fuchs, Ephraim J.
N1 - Funding Information:
Financial disclosure: Supported by grants from the National Institutes of Health ( P01 CA015396 , to R.J.J. and K23 CA124465 , to Y.L.K.) and a Scholar in Clinical Research Award from the Leukemia and Lymphoma Society of America (to E.J.F.).
PY - 2010/4
Y1 - 2010/4
N2 - 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 -DRB1 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.
AB - 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 -DRB1 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.
KW - Allogeneic blood or marrow transplantation
KW - Cyclophosphamide
KW - Graft-versus-host disease
KW - Human leukocyte antigen
KW - Nonmyeloablative conditioning
UR - http://www.scopus.com/inward/record.url?scp=77649342341&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77649342341&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2009.11.011
DO - 10.1016/j.bbmt.2009.11.011
M3 - Article
C2 - 19925877
AN - SCOPUS:77649342341
SN - 1083-8791
VL - 16
SP - 482
EP - 489
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 4
ER -