Changes in the clinical impact of high-risk human leukocyte antigen allele mismatch combinations on the outcome of unrelated bone marrow transplantation

Yoshinobu Kanda, Junya Kanda, Yoshiko Atsuta, Shigeo Fuji, Yoshinobu Maeda, Tastuo Ichinohe, Minoko Takanashi, Kazuteru Ohashi, Takahiro Fukuda, Koichi Miyamura, Takehiko Mori, Hiroshi Sao, Naoki Kobayashi, Koji Iwato, Akihisa Sawada, Shinichiro Mori

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Abstract

Several high-risk HLA allele mismatch combinations (HR-MMs) for severe acute graft-versus-host disease (GVHD) have been identified by analyzing transplantation outcomes in Japanese unrelated hematopoietic stem cell transplant recipients. In this study, we analyzed the effects of HR-MMs in 3 transplantation time periods. We confirmed that the incidence of grade III to IV acute GVHD in the HR-MM group was significantly higher than that in the low-risk (LR) MM group (hazard ratio [HR], 2.74; P<.0001) in the early time period (1993 to 2001). However, the difference in the incidence of grade III to IV acute GVHD between the HR-MM and LR-MM groups was not statistically significant (HR, 1.06; P=.85 and HR, .40; P=.21, respectively) in the mid (2002 to 2007) and late (2008 to 2011) time periods. Similarly, survival in the HR-MM group was significantly inferior to that in the LR-MM group (HR, 1.46; P=.019) in the early time period, whereas the difference in survival between the 2 groups was not statistically significant in the mid and late time periods (HR, 1.06; P=.75 and HR, .82; P=.58, respectively). In conclusion, the adverse impact of HR-MM has become less significant over time. Unrelated transplantation with a single HR-MM could be a viable option in the absence of a matched unrelated donor or an unrelated donor with a single LR-MM.

Original languageEnglish
Pages (from-to)526-535
Number of pages10
JournalBiology of Blood and Marrow Transplantation
Volume20
Issue number4
DOIs
Publication statusPublished - 2014

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Keywords

  • Bone marrow transplantation
  • Graft-versus-host disease
  • Human leukocyte antigens
  • Leukemia

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

Kanda, Y., Kanda, J., Atsuta, Y., Fuji, S., Maeda, Y., Ichinohe, T., Takanashi, M., Ohashi, K., Fukuda, T., Miyamura, K., Mori, T., Sao, H., Kobayashi, N., Iwato, K., Sawada, A., & Mori, S. (2014). Changes in the clinical impact of high-risk human leukocyte antigen allele mismatch combinations on the outcome of unrelated bone marrow transplantation. Biology of Blood and Marrow Transplantation, 20(4), 526-535. https://doi.org/10.1016/j.bbmt.2014.01.003