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Prepublished online as a Blood First Edition Paper on April 24, 2003; DOI 10.1182/blood-2003-02-0430.
Submitted February 10, 2003
Accepted April 12, 2003
Allogeneic hematopoietic stem cell transplantation from family members other than HLA-identical siblings over the last decade (1991-2000)
Yoshinobu Kanda, Shigeru Chiba, Hisamaru Hirai, Hisashi Sakamaki, Tohru Iseki, Yoshihisa Kodera, Takahiro Karasuno, Shinichiro Okamoto, Noriyuki Hirabayashi, Koji Iwato, Atsuo Maruta, Yoshihiro Fujimori, Tatsuo Furukawa, Shin Mineishi, Keitaro Matsuo, Nobuyuki Hamajima, and Masahiro Imamura*
Department of Cell Therapy & Transplantation Medicine, University of Tokyo, Tokyo, Japan
Hematology Division, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
Japanese Red Cross Nagoya First Hospital, Aichi, Japan
5th Department of Medicine, Osaka Medical Center for Cancer & Cardiovascular Diseases, Osaka, Japan
Keio University School of Medicine, Tokyo, Japan
Department of Hematology, Nagoya Daini Red Cross Hospital, Aichi, Japan
Department of Internal Medicine, Hiroshima Atomic Bomb Survivors Hospital, Hiroshima, Japan
Department of Hematology, Kanagawa Cancer Center, Kanagawa, Japan
Department of Medicine, Hyogo College of Medicine, Hyogo, Japan
Division of Bone Marrow Transplantation, Niigata University Medical Hospital, Niigata, Japan
Stem Cell Transplant Unit, National Cancer Center Hospital, Tokyo, Japan
Division of Epidemiology & Prevention, Aichi Cancer Center Research Institute, Aichi, Japan
Department of Hematology & Oncology, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
* Corresponding author; email: mimamura{at}med.hokudai.ac.jp.
The reported outcome of hematopoietic stem cell transplantation (HSCT) from HLA-mismatched family members has been inconsistent. The object of the study was to evaluate the true impact of HLA-mismatch by using recent data from a homogenous population, excluding HSCT that used graft manipulations, and by considering genotypical matching. Clinical data of 2,947 patients who underwent allogeneic HSCT for leukemia or myelodysplastic syndrome were extracted from the database of the Japan Society for Hematopoietic Cell Transplantation. The main outcome measures were survival and the incidence of graft-versus-host disease (GVHD). The presence of serological HLA-mismatch, higher age, and high-risk disease were identified as independent risk factors for both shorter survival and the development of grade III-IV acute GVHD. The impact of HLA-mismatch on survival was more relevant in standard-risk patients. These findings persisted when we used genotypical HLA-matching. Survival after 1-locus-mismatched HSCT was equivalent to that after HLA-matched unrelated HSCT. We concluded that when a 1-locus-mismatched family donor is available for high-risk patients, immediate HSCT using this donor is warranted. In standard-risk patients, however, survival after 1-locus-mismatched HSCT is significantly shorter than that after HLA-matched HSCT, and the indications for HSCT should be considered carefully.
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