Recipient/donor HLA and CMV matching in recipients of T-cell-depleted unrelated donor haematopoietic cell transplants.

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Publication Date
2017-05ICR Author
Author
Shaw, BE
Mayor, NP
Szydlo, RM
Bultitude, WP
Anthias, C
Kirkland, K
Perry, J
Clark, A
Mackinnon, S
Marks, DI
Pagliuca, A
Potter, MN
Russell, NH
Thomson, K
Madrigal, JA
Marsh, SGE
Type
Journal Article
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Show full item recordAbstract
Improving haematopoietic cell transplantation outcomes by selection of an HLA-matched unrelated donor is best practice; however, donor selection by secondary characteristics is controversial. We studied 1271 recipients with haematological malignancies who underwent T-cell-depleted allografts and had complete data on HLA-matching status for six loci (HLA-A, -B, -C, -DRB1, -DQB1, -DPB1) and clinical outcome data. Five-year overall survival was 40.6%. HLA mismatching (at HLA-A, -B, -C, -DRB1, -DQB1) relative risk (RR) 1.22, 95% confidence interval (CI) 1.2-1.5, P=0.033 for 1 mismatch and RR 1.46, 95% CI 1.1-1.9, P=0.009 for >1 mismatch) and CMV mismatching (RR 1.37, 95% CI 1.2-1.6, P<0.001) were significantly associated with inferior survival. Donors aged <30 years showed a trend towards better survival. The multivariate model for mortality, combining CMV and HLA-match status, found an RR of 1.36 (95% CI 1.1-1.7, P=0.003) for HLA matched/CMV mismatched, an RR of 1.22 (95% CI 0.99-1.5, P=0.062) for HLA mismatched/CMV matched and an RR of 1.81 (95% CI 1.4-2.3, P=<0.001) for HLA/ CMV mismatched, compared with the HLA/CMV-matched recipients. These data suggest that HLA and CMV matching status should be considered when selecting unrelated donors and that CMV matching may abrogate the effect of an HLA mismatch.
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Subject
Humans
Cytomegalovirus
Hematologic Neoplasms
HLA Antigens
Serologic Tests
Lymphocyte Depletion
Hematopoietic Stem Cell Transplantation
Risk Factors
Survival Analysis
Histocompatibility
Adolescent
Adult
Aged
Middle Aged
Child
Child, Preschool
Female
Male
Young Adult
Unrelated Donors
Language
eng
Date accepted
2016-11-21
License start date
2017-05
Citation
Bone marrow transplantation, 2017, 52 (5), pp. 717 - 725