TY - JOUR
T1 - Tacrolimus Does Not Abrogate the Increased Risk of Acute Graft-Versus-Host Disease after Unrelated-Donor Marrow Transplantation with Allelic Mismatching at HLA-DRB1 and HLA-DQB1
AU - Przepiorka, Donna
AU - Saliba, Rima
AU - Cleary, Karen
AU - Fischer, Harald
AU - Tonai, Richard
AU - Fritsche, Herbert
AU - Khouri, Issa F.
AU - Folloder, Jody
AU - Ueno, Naoto T.
AU - Mehra, Rakesh
AU - Ippoliti, Cindy
AU - Giralt, Sergio
AU - Gajewski, James
AU - Donato, Michele
AU - Claxton, David
AU - Braunschweig, Ira
AU - Van Besien, Koen
AU - Anderlini, Paolo
AU - Andersson, Borje S.
AU - Champlin, Richard
PY - 2000
Y1 - 2000
N2 - One hundred patients of median age 34 years (range, 14-53) received bone marrow transplants from unrelated donors serologically matched for human leukocyte antigen HLA-A, HLA-B, and HLA-DR using tacrolimus and minimethotrexate for prevention of acute graft-versus-host disease (GVHD). Sixty-eight patient-donor pairs had allelic matches at HLA-DRB1 and HLA-DQB1, 20 pairs had a single mismatch at HLA-DRB1 or HLA-DQB1, and 12 were mismatched at both HLA-DRB1 and HLA-DQB1. Minimum follow-up time was 6 months. Grades 2 to 4 GVHD occurred in 43% of patients with matched donors, 69% with single allele-mismatched donors, and 71% with double allele-mismatched donors; grades 3 to 4 GVHD occurred in 22%, 43%, and 64%, respectively. On multivariate analysis, the relative risk of grades 2 to 4 GVHD was 2.2 (95% CI, 1.1-4.5; P = .03) with a single allele mismatch and 2.7 (95% CI, 1.2-6.0; P = .02) with a double allele mismatch. The relative risks of grades 3 to 4 GVHD were 3.0 (95% CI, 1.2-7.6; P = .02) and 5.0 (95% CI, 1.9-12.6; P = .001), respectively. Day 100 treatment-related mortality was also adversely affected by allelic mismatching, occurring in 21% of those with matched donors, 50% with single allele-mismatched donors, and 42% with double allele-mismatched donors (P = .02), but overall survival at day 180 did not differ significantly among the 3 groups. Tacrolimus does not abrogate the adverse impact of allele mismatching at HLA-DRB1 and HLA-DQB1 on the risk of moderate-to-severe acute GVHD.
AB - One hundred patients of median age 34 years (range, 14-53) received bone marrow transplants from unrelated donors serologically matched for human leukocyte antigen HLA-A, HLA-B, and HLA-DR using tacrolimus and minimethotrexate for prevention of acute graft-versus-host disease (GVHD). Sixty-eight patient-donor pairs had allelic matches at HLA-DRB1 and HLA-DQB1, 20 pairs had a single mismatch at HLA-DRB1 or HLA-DQB1, and 12 were mismatched at both HLA-DRB1 and HLA-DQB1. Minimum follow-up time was 6 months. Grades 2 to 4 GVHD occurred in 43% of patients with matched donors, 69% with single allele-mismatched donors, and 71% with double allele-mismatched donors; grades 3 to 4 GVHD occurred in 22%, 43%, and 64%, respectively. On multivariate analysis, the relative risk of grades 2 to 4 GVHD was 2.2 (95% CI, 1.1-4.5; P = .03) with a single allele mismatch and 2.7 (95% CI, 1.2-6.0; P = .02) with a double allele mismatch. The relative risks of grades 3 to 4 GVHD were 3.0 (95% CI, 1.2-7.6; P = .02) and 5.0 (95% CI, 1.9-12.6; P = .001), respectively. Day 100 treatment-related mortality was also adversely affected by allelic mismatching, occurring in 21% of those with matched donors, 50% with single allele-mismatched donors, and 42% with double allele-mismatched donors (P = .02), but overall survival at day 180 did not differ significantly among the 3 groups. Tacrolimus does not abrogate the adverse impact of allele mismatching at HLA-DRB1 and HLA-DQB1 on the risk of moderate-to-severe acute GVHD.
KW - HLA-DQB1
KW - HLA-DRB1
KW - Tacrolimus
KW - Unrelated-donor marrow transplantation
UR - http://www.scopus.com/inward/record.url?scp=0033658448&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0033658448&partnerID=8YFLogxK
U2 - 10.1016/S1083-8791(00)70042-5
DO - 10.1016/S1083-8791(00)70042-5
M3 - Article
C2 - 10816027
AN - SCOPUS:0033658448
SN - 1083-8791
VL - 6
SP - 190
EP - 197
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 2 A
ER -