Impact of the presence of HLA 1-locus mismatch and the use of low-dose antithymocyte globulin in unrelated bone marrow transplantation.

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Abstract

HLA 1-locus-mismatched unrelated donors (1MMUD) have been used in allogeneic hematopoietic stem cell transplantation (allo-HCT) for patients who lack an HLA-matched donor. We retrospectively analyzed 3313 patients with acute leukemia or myelodysplastic syndrome who underwent bone marrow transplantation from an HLA allele-matched unrelated donor (MUD) or 1MMUD between 2009 and 2014. We compared the outcomes of MUD (n=2089) and 1MMUD with antithymocyte globulin (ATG) (1MM-ATG(+); n=109) with those of 1MMUD without ATG (1MM-ATG(-); n=1115). The median total dose of ATG (thymoglobulin) was 2.5 mg/kg (range 1.0-11.0 mg/kg) in the 1MM-ATG(+) group. The rates of grade III-IV acute GvHD, non-relapse mortality (NRM) and overall mortality were significantly lower in the MUD group than in the 1MM-ATG(-) group (hazard ratio (HR) 0.77, P=0.016; HR 0.74; P<0.001; and HR 0.87, P=0.020, respectively). Likewise, the rates of grade III-IV acute GVHD, NRM and overall mortality were significantly lower in the 1MM-ATG(+) group than in the 1MM-ATG(-) group (HR 0.42, P=0.035; HR 0.35, P<0.001; and HR 0.71, P=0.042, respectively). The outcome of allo-HCT from 1MM-ATG(-) was inferior to that of allo-HCT from MUD even in the recent cohort. However, the negative impact of 1MMUD disappeared with the use of low-dose ATG without increasing the risk of relapse.Bone Marrow Transplantation advance online publication, 17 July 2017; doi:10.1038/bmt.2017.153.

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Journal

Journal ID (iso-abbrev): Bone Marrow Transplant.

Title: Bone marrow transplantation

Publisher: Springer Nature

ISSN (Electronic): 1476-5365

ISSN (Print): 0268-3369

Publication date (Electronic): Jul 17 2017

Affiliations

[1 ] Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

[2 ] Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

[3 ] Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.

[4 ] Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

[5 ] Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.

[6 ] Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.

[7 ] Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.

[8 ] Department of Hematology, Toranomon Hospital, Tokyo, Japan.

[9 ] Department of Blood Transfusion, Hiroshima Red Cross and Atomic Bomb Survivors Hospital, Hiroshima, Japan.

[10 ] Leukemia Research Center, Saiseikai Maebashi Hospital, Gunma, Japan.

[11 ] Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.

[12 ] Department of Hematology/Division of Stem Cell Transplantation, Kobe General Hospital/Institute of Biomedical Research and Innovation, Kobe, Japan.

[13 ] Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.

[14 ] Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.

[15 ] Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.

[16 ] Division of Hematology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.

Article

Publisher Item ID: bmt2017153

DOI: 10.1038/bmt.2017.153

PubMed ID: 28714944

SO-VID: 8df58e7d-e1cd-4857-8ff8-b9607b46bd41

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