Allelic HLA Matching and Pair Origin Are Favorable Prognostic Factors for Unrelated Hematopoietic Stem Cell Transplantation in Neoplastic Hematologic Diseases: An Italian Analysis by the Gruppo Italiano Trapianto di Cellule Staminali e Terapie Cellulari, Italian Bone Marrow Donor Registry, and Associazione Italiana di Immunogenetica e Biologia dei Trapianti.

Abstract

HLA molecules are important for immunoreactivity in allogeneic hematopoietic stem cell transplantation (HSCT). The Gruppo Italiano Trapianto di Cellule Staminali e Terapie Cellulari, Italian Bone Marrow Donor Registry, and Associazione Italiana di Immunogenetica e Biologia dei Trapianti promoted a retrospective observational study to evaluate HLA matching and the impact of allelic HLA mismatching and non-HLA factors on unrelated Italian HSCT outcomes. From 2012 to 2015, 1788 patients were enrolled in the study. The average donor age was 29 years and the average recipient age was 49 years. As a conditioning regimen, 71% of the patients received myeloablative conditioning. For GVHD prophylaxis, 76% received either antithymocyte or anti-T lymphocyte globulin, cyclosporine A, and methotrexate. Peripheral blood was the stem cell source in 80%. The median duration of follow-up was 53 months. Regarding HLA matching, 50% of donor-recipient pairs were 10/10 matched, 38% had 1 mismatch, and 12% had 2 or more mismatches. A total of 302 pairs shared Italian origin. Four-year overall survival (OS), progression-free survival, GVHD-free relapse-free survival, and relapse rates were 49%, 40%, 22%, and 34%, respectively. The 4-year NRM was 27%, and the 100-day cumulative incidence of grade ≥II acute GVHD (aGVHD) was 26%. In multivariate analysis, 9/10 and ≤8/10 HLA allele-matched pairs were associated with worse OS (P = .04 and .007, respectively), NRM (P = .007 and P < .0001, respectively), and grade III-IV aGVHD (P = .0001 and .01, respectively). Moreover, the incidences of grade II-IV aGVHD (P = .001) and chronic GVHD (P = .002) were significantly lower in Italian pairs. In conclusion, 10/10 HLA matching is a favorable prognostic factor for unrelated HSCT outcome in the Italian population. Moreover, the presence of 2 HLA-mismatched loci was associated with a higher NRM (P < .0001) and grade II-IV aGVHD (P = .006) and a poorer OS (P = .001) compared with 1 HLA-mismatched locus in early or intermediate disease phases. Finally, we found that Italian donor and recipient origin is a favorable prognostic factor for GVHD occurrence.

• Authors: Alessandra Picardi, Nicoletta Sacchi, Valeria Miotti, Francesca Lorentino, Elena Oldani, Alessandro Rambaldi, Mariarosaria Sessa, Benedetto Bruno, Michela Cerno, Luca Vago, Paolo Bernasconi, William Arcese, Fabio Benedetti, Pietro Pioltelli, Domenico Russo, Lucia Farina, Franca Fagioli, Stefano Guidi, Giorgia Saporiti, Francesco Zallio, Patrizia Chiusolo, Carlo Borghero, Gabriele Papalinetti, Ursula La Rocca, Giuseppe Milone, Teresa Lamparelli, Angelo M Carella, Mario Luppi, Attilio Olivieri, Massimo Martino, Paola Carluccio, Ivana Celeghini, Marco Andreani, Anna M Gallina, Francesca Patriarca, Simona Pollichieni, Sonia Mammoliti, Silvia Miccichè, Ilaria Mangione, Fabio Ciceri, Francesca Bonifazi
• Journal: Transplantation and cellular therapy (Transplant Cell Ther) Vol. 27 Issue 5 Pg. 406.e1-406.e11 (05 2021) ISSN: 2666-6367 [Electronic] United States
• PMID: 33965179 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Alleles
• Bone Marrow
• Hematologic Diseases
• Hematopoietic Stem Cell Transplantation
• Humans
• Italy
• Middle Aged
• Neoplasm Recurrence, Local
• Prognosis
• Registries