SEARCH:   Advanced

Blood, 13 August 2009, Vol. 114, No. 7, pp. 1437-1444. Prepublished online as a Blood First Edition Paper on June 10, 2009; DOI 10.1182/blood-2009-01-200378. This Article Full Text Full Text (PDF) Supplemental Appendix All Versions of this Article: blood-2009-01-200378v1 114/7/1437    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Google Scholar Articles by Crocchiolo, R. Articles by Fleischhauer, K. PubMed PubMed Citation Articles by Crocchiolo, R. Articles by Fleischhauer, K. Related Collections Transplantation Free Research Articles Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  TRANSPLANTATION Nonpermissive HLA-DPB1 disparity is a significant independent risk factor for mortality after unrelated hematopoietic stem cell transplantation Roberto Crocchiolo1,2, Elisabetta Zino3, Luca Vago1,3,4, Rosi Oneto5, Barbara Bruno5, Simona Pollichieni6, Nicoletta Sacchi6, Maria Pia Sormani2, Jessica Marcon3,4, Teresa Lamparelli5, Renato Fanin7, Lucia Garbarino8, Valeria Miotti9, Giuseppe Bandini10, Alberto Bosi11, Fabio Ciceri1, Andrea Bacigalupo5, Katharina Fleischhauer3,4, and for the Gruppo Italiano Trapianto di Midollo Osseo, Cellule Staminale Ematopoietiche (CSE) e Terapia Cellulare, and the Italian Bone Marrow Donor Registry 1 Hematology and Bone Marrow Transplantation Unit, Department of Oncology, San Raffaele Scientific Institute, Milano, Italy; 2 Biostatistics Unit, Department of Health Sciences, University of Genova, Genova; 3 Immunogenetics Laboratory, Unit of Immunohematology and Blood Transfusion, Division of Regenerative Medicine and Stem Cell Therapy, San Raffaele Scientific Institute, Milano; 4 San Raffaele Telethon Institute for Gene Therapy, Division of Regenerative Medicine and Stem Cell Therapy, San Raffaele Scientific Institute, Milano; 5 Division of Hematology, Ospedale San Martino, Genova; 6 Italian Bone Marrow Donor Registry, Ospedale Galliera, Genova; 7 Division of Hematology and Bone Marrow Transplantation, University of Udine, Udine; 8 Immunogenetics Laboratory, Ospedale San Martino, Genova; 9 Tissue Typing Laboratory, Azienda Ospedaliera S. M. Misericordia, Udine; 10 Institute of Hematology L. & A. Seragnoli, University of Bologna, Bologna; and 11 Department of Hematology, University of Florence, Florence, Italy The importance of donor-recipient human leukocyte antigen (HLA)-DPB1 matching for the clinical outcome of unrelated hematopoietic stem cell transplantation (HSCT) is controversial. We have previously described an algorithm for nonpermissive HLA-DPB1 disparities involving HLA-DPB1*0901,*1001,*1701,*0301,*1401,*4501, based on T-cell alloreactivity patterns. By revisiting the immunogenicity of HLA-DPB1*02, a modified algorithm was developed and retrospectively tested in 621 unrelated HSCTs facilitated through the Italian Registry for oncohematologic adult patients. The modified algorithm proved to be markedly more predictive of outcome than the original one, with significantly higher Kaplan-Meier probabilities of 2-year survival in permissive compared with nonpermissive transplantations (55% vs 39%, P = .005). This was the result of increased adjusted hazards of nonrelapse mortality (hazard ratio [HR] = 1.74; confidence interval [CI], 1.19-2.53; P = .004) but not of relapse (HR = 1.02; CI, 0.73-1.42; P = .92). The increase in the hazards of overall mortality by nonpermissive HLA-DPB1 disparity was similar in 10 of 10 (HR = 2.12; CI, 1.23-3.64; P = .006) and 9 of 10 allele-matched transplantations (HR = 2.21; CI, 1.28-3.80; P = .004), both in early-stage and in advanced-stage disease. These data call for revisiting current HLA matching strategies for unrelated HSCT, suggesting that searches should be directed up-front toward identification of HLA-DPB1 permissive, 10 of 10 or 9 of 10 matched donors. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

	Copyright © 2009 by American Society of Hematology         Online ISSN: 1528-0020