One-Antigen Mismatched Related versus HLA-Matched Unrelated Donor Hematopoietic Stem Cell Transplantation in Adults with Acute Leukemia: Center for International Blood and Marrow Transplant Research Results in the Era of Molecular HLA Typing

David Valcárcel, Jorge Sierra, Tao Wang, Fangyu Kan, Vikas Gupta, Gregory A. Hale, David I. Marks, Philip L. McCarthy, Machteld Oudshoorn, Effie W. Petersdorf, Olle Ringdén, Michelle Setterholm, Stephen R. Spellman, Edmund K. Waller, James L. Gajewski, Susana R. Marino, David Senitzer, Stephanie J. Lee

    Research output: Contribution to journalArticle

    39 Citations (Scopus)

    Abstract

    Approximately 13% of patients lacking an HLA-identical sibling have a one-antigen-mismatched related donor (MMRD). Historically, outcomes from the use of a one-antigen MMRD were considered equivalent to those from the use of a matched unrelated donor (UD). Recent improvements in UD stem cell transplantation (SCT) resulting from better molecular HLA matching justifies investigating whether UD should be preferred over MMRD in adult patients with acute leukemia. Here, we compared the outcomes of MMRD (n = 89) and HLA-A, -B, -C, and -DRB1 allele-matched UD (n = 700) SCT reported to the Center for International Blood and Marrow Transplant Research between 1995 and 2005. The patients underwent transplantation for acute myelogenous leukemia or acute lymphoblastic leukemia in first or second complete remission. Donor type was not associated with hematologic recovery. Univariate and multivariate comparisons of MMRD versus HLA-matched UD transplants showed no statistically significant differences in overall survival, disease-free survival, treatment-related mortality, relapse, or 100-day grade III-IV acute graft-versus-host disease (GVHD). MMRD SCT was associated with a lower rate of chronic GVHD at 1 year (35% vs 47%; P = .03), which was confirmed by multivariate analysis (relative risk, 0.58; 95% confidence interval, 0.39-0.85; P <.01). According to our data, HLA-matched UD and MMRD SCT are associated with comparable survival. Given that less chronic GVHD was observed in the MMRD transplantations, this option, when available, remains the first choice in patients with acute leukemia without an HLA-identical sibling in need of allogeneic SCT.

    Original languageEnglish (US)
    Pages (from-to)640-648
    Number of pages9
    JournalBiology of Blood and Marrow Transplantation
    Volume17
    Issue number5
    DOIs
    StatePublished - May 2011

    Fingerprint

    Molecular Typing
    Histocompatibility Testing
    Unrelated Donors
    Hematopoietic Stem Cell Transplantation
    Leukemia
    Bone Marrow
    Tissue Donors
    Stem Cell Transplantation
    Transplants
    Antigens
    Research
    Graft vs Host Disease
    Siblings
    Transplantation
    HLA-A Antigens
    HLA-B Antigens
    Survival
    Precursor Cell Lymphoblastic Leukemia-Lymphoma
    Acute Myeloid Leukemia
    Disease-Free Survival

    Keywords

    • Acute lymphoblastic leukemia
    • Acute myelogenous leukemia
    • Allogeneic transplantation
    • HLA match

    ASJC Scopus subject areas

    • Transplantation
    • Hematology

    Cite this

    One-Antigen Mismatched Related versus HLA-Matched Unrelated Donor Hematopoietic Stem Cell Transplantation in Adults with Acute Leukemia : Center for International Blood and Marrow Transplant Research Results in the Era of Molecular HLA Typing. / Valcárcel, David; Sierra, Jorge; Wang, Tao; Kan, Fangyu; Gupta, Vikas; Hale, Gregory A.; Marks, David I.; McCarthy, Philip L.; Oudshoorn, Machteld; Petersdorf, Effie W.; Ringdén, Olle; Setterholm, Michelle; Spellman, Stephen R.; Waller, Edmund K.; Gajewski, James L.; Marino, Susana R.; Senitzer, David; Lee, Stephanie J.

    In: Biology of Blood and Marrow Transplantation, Vol. 17, No. 5, 05.2011, p. 640-648.

    Research output: Contribution to journalArticle

    Valcárcel, D, Sierra, J, Wang, T, Kan, F, Gupta, V, Hale, GA, Marks, DI, McCarthy, PL, Oudshoorn, M, Petersdorf, EW, Ringdén, O, Setterholm, M, Spellman, SR, Waller, EK, Gajewski, JL, Marino, SR, Senitzer, D & Lee, SJ 2011, 'One-Antigen Mismatched Related versus HLA-Matched Unrelated Donor Hematopoietic Stem Cell Transplantation in Adults with Acute Leukemia: Center for International Blood and Marrow Transplant Research Results in the Era of Molecular HLA Typing', Biology of Blood and Marrow Transplantation, vol. 17, no. 5, pp. 640-648. https://doi.org/10.1016/j.bbmt.2010.07.022
    Valcárcel, David ; Sierra, Jorge ; Wang, Tao ; Kan, Fangyu ; Gupta, Vikas ; Hale, Gregory A. ; Marks, David I. ; McCarthy, Philip L. ; Oudshoorn, Machteld ; Petersdorf, Effie W. ; Ringdén, Olle ; Setterholm, Michelle ; Spellman, Stephen R. ; Waller, Edmund K. ; Gajewski, James L. ; Marino, Susana R. ; Senitzer, David ; Lee, Stephanie J. / One-Antigen Mismatched Related versus HLA-Matched Unrelated Donor Hematopoietic Stem Cell Transplantation in Adults with Acute Leukemia : Center for International Blood and Marrow Transplant Research Results in the Era of Molecular HLA Typing. In: Biology of Blood and Marrow Transplantation. 2011 ; Vol. 17, No. 5. pp. 640-648.
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    abstract = "Approximately 13{\%} of patients lacking an HLA-identical sibling have a one-antigen-mismatched related donor (MMRD). Historically, outcomes from the use of a one-antigen MMRD were considered equivalent to those from the use of a matched unrelated donor (UD). Recent improvements in UD stem cell transplantation (SCT) resulting from better molecular HLA matching justifies investigating whether UD should be preferred over MMRD in adult patients with acute leukemia. Here, we compared the outcomes of MMRD (n = 89) and HLA-A, -B, -C, and -DRB1 allele-matched UD (n = 700) SCT reported to the Center for International Blood and Marrow Transplant Research between 1995 and 2005. The patients underwent transplantation for acute myelogenous leukemia or acute lymphoblastic leukemia in first or second complete remission. Donor type was not associated with hematologic recovery. Univariate and multivariate comparisons of MMRD versus HLA-matched UD transplants showed no statistically significant differences in overall survival, disease-free survival, treatment-related mortality, relapse, or 100-day grade III-IV acute graft-versus-host disease (GVHD). MMRD SCT was associated with a lower rate of chronic GVHD at 1 year (35{\%} vs 47{\%}; P = .03), which was confirmed by multivariate analysis (relative risk, 0.58; 95{\%} confidence interval, 0.39-0.85; P <.01). According to our data, HLA-matched UD and MMRD SCT are associated with comparable survival. Given that less chronic GVHD was observed in the MMRD transplantations, this option, when available, remains the first choice in patients with acute leukemia without an HLA-identical sibling in need of allogeneic SCT.",
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