Impact on Outcomes of Human Leukocyte Antigen Matching by Allele-Level Typing in Adults with Acute Myeloid Leukemia Undergoing Umbilical Cord Blood Transplantation

Autores de IIS La Fe

• Jaime Sanz Caballer

  Autor

• Dolores Planelles Silvestre

  Autor

• Pau Montesinos Fernández

  Autor

• Jose Ignacio Lorenzo Herrero

  Autor

• Federico Moscardo Garcia

  Autor

• Guillermo Martin Aragones

  Autor

• Francisca Lopez Chulia

  Autor

• Jesus Antonio Martinez Dominguez

  Autor

• Isidro Jarque Ramos

  Autor

• 

  Javier De La Rubia Comos

  Autor

• Luis Larrea Gonzalez

  Autor

• Miguel Ángel Sanz Alonso

  Autor

• Guillermo Sanz Santillana

  Autor

Participantes ajenos a IIS La Fe

• Jaramillo FJ

Grupos

• Hematología y Hemoterapia

Abstract

This retrospective study analyzed the impact of directional donor-recipient human leukocyte antigen (HLA) disparity using allele-level typing at HLA-A, -B, -C, and -DRB1 in 79 adults with acute myeloid leukemia (AML) who received single-unit umbilical cord blood (UCB) transplant at a single institution. With extended high-resolution HLA typing, the donor-recipient compatibility ranged from 218 to 8/8. HLA disparity showed no negative impact on nonrelapse mortality (NRM), graft-versus-host (GVH) disease or engraftment. Considering disparities in the GVH direction, the 5-year cumulative incidence of relapse was 44% and 22% for patients receiving an UCB unit matched >= 6/8 and <6/8, respectively (P = .04). In multivariable analysis, a higher HLA disparity in the GVH direction using extended high-resolution typing (Risk ratio [RR] 2.8; 95% confidence interval [CI], 1.5 to 5.1; P = .0009) and first complete remission at time of transplantation (RR 2.1; 95% CI, 1.2 to 3.8; P = .01) were the only variables significantly associated with an improved disease-free survival. In conclusion, we found that in adults with AML undergoing single-unit UCBT, an increased number of HLA disparities at allele-level typing improved disease-free survival by decreasing the relapse rate without a negative effect on NRM. (C) 2014 American Society for Blood and Marrow Transplantation.

Keywords

• Umbilical cord blood; Human leukocyte antigen (HLA); Acute myeloid leukemia