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Stem Cell Transplantation
Ferrata Storti Foundation
Haematologica 2019 Volume 104(5):1055-1061
ABSTRACT
Second allogeneic hematopoietic stem cell transplantation is a cura- tive treatment option for patients with hematologic malignancies. However, it is unclear whether HLA discrepancy between graft and first donor has an impact on the outcome of second transplantation. We retrospectively analyzed 646 patients receiving second transplantation after an initial HLA mismatched transplantation. With regard to graft-versus-host, the one-allele mismatch (1 mismatch) group (SHR, 1.88; 95%CI: 0.79-4.45; P=0.163) and more than one-allele mismatch group (≥ 2 mismatch) (SHR, 1.84; 95%CI, 0.75–4.51; P=0.182) had high- er risks of grade III–IV acute graft-versus-host disease (GvHD) compared to the HLA-matched (0 mismatch) group. In contrast, no difference in risk of acute GvHD was found among the 0, 1, and ≥ 2 mismatch group with respect to graft-versus-first donor. With regard to graft-versus-host, the ≥ 2 mismatch group showed a significantly higher risk of treatment- related mortality (SHR, 1.90; 95%CI, 1.04–3.50; P=0.038) compared to the 0 mismatch group, while the risk of relapse was slightly lower in the ≥ 2 mismatch group (SHR, 068; 95%CI, 0.44–1.06; P=0.086). In contrast, with regard to graft-versus-first donor, there were no significant differ- ences in treatment-related mortality or relapse among the three groups. These findings suggested that HLA discrepancy between graft and host induces transplant-related immunological responses in second transplan- tation leading to an increase in treatment-related mortality, in contrast, the biological effects of HLA discrepancy between graft and first donor on outcome may be negligible.
Correspondence:
YOSHINOBU MAEDA yosmaeda@md.okayama-u.ac.jp
Received: August 20, 2018. Accepted: November 23, 2018. Pre-published: December 6, 2018.
doi:10.3324/haematol.2018.204438
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haematologica | 2019; 104(5)
1055
HLA discrepancy between graft and host rather than that graft and first donor impact the second transplant outcome
Yoshinobu Maeda,1* Tomotaka Ugai,2,3* Eisei Kondo,4 Kazuhiro Ikegame,5 Makoto Murata,6 Naoyuki Uchida,7 Toshihiro Miyamoto,8 Satoshi Takahashi,9 Kazuteru Ohashi,10 Hirohisa Nakamae,11 Takahiro Fukuda,12
Makoto Onizuka,13 Tetsuya Eto,14 Shuichi Ota,15 Makoto Hirokawa,16
Tatsuo Ichinohe,17 Yoshiko Atsuta,18 Yoshinobu Kanda3,19 and Junya Kanda;20 on behalf of the HLA Working Group of the Japan Society for Hematopoietic Cell Transplantation
1Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; 2Division of Cancer Epidemiology and Prevention, Department of Preventive Medicine, Aichi Cancer Center Research Institute, Nagoya; 3Division of Hematology, Saitama Medical Center, Jichi Medical University, Tochigi; 4Division of Hematology, Department of Medicine, Kawasaki Medical School, Okayama; 5Division of Hematology, Department of Internal Medicine, Hyogo Medical College; 6Department of Hematology and Oncology, Nagoya University Graduate School of Medicine; 7Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo; 8Hematology, Oncology & Cardiovascular medicine, Kyushu University Hospital, Fukuoka; 9Division of Molecular Therapy, The Advanced Clinical Research Center, The Institute of Medical Science, The University of Tokyo; 10Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo; 11Department of Hematology, Osaka City University Hospital; 12Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo; 13Department of Hematology/Oncology, Tokai University School of Medicine, Kanagawa; 14Department of Hematology, Hamanomachi Hospital, Fukuoka; 15Department of Hematology, Sapporo Hokuyu Hospital, Hokkaido; 16Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine; 17Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine (RIRBM), Hiroshima University; 18Department of Healthcare Administration, Nagoya University Graduate School of Medicine; 19Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi and 20Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Japan
*YM and TU contributed equally to this work.
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