Outcomes of peripheral blood stem cell transplantation in patients from human leukocyte antigen matched or mismatched unrelated donors / 中华医学杂志(英文版)

ABSTRACT

<p><b>BACKGROUND</b>Allogeneic peripheral blood stem cell transplantation from unrelated donors (UR-PBSCT) is an alternative treatment for many hematologic diseases due to lack of human leukocyte antigen (HLA)-identical sibling donors. This study aimed to evaluate the impact of the degree of the HLA match on the clinical efficacy of UR-PBSCT.</p><p><b>METHODS</b>Patients who underwent UR-PBSCT from September 2003 to September 2012 were retrospectively investigated. They were divided into three groups according to high-resolution molecular typing. SPSS version 17.0 was used to analysis and compare the statistics of engraftment, incidence of GVHD, other complications and survival among the groups.</p><p><b>RESULTS</b>One hundred and eleven patients received UR-PBSCT, 60 of them with an HLA matched donor (10/10), 36 of them with a one locus mismatched donor (9/10), and 15 of them with a two loci mismatched donor (8/10). Similar basic characteristics were found in the three groups. No differences were found in engraftment of myeloid cells or platelets in the three groups (P > 0.05). Two-year cumulative incidence of relapse, overall survival (OS) and disease-free survival (DFS) among those three groups were similar (P > 0.05). The cumulative incidence of 100-day III-IV aGVHD in the HLA matched group and the one HLA locus mismatched group were significantly lower than that in the two HLA loci mismatched group (3.3%, 8.6%, and 26.7%, P = 0.009). The occurrence rate of new pulmonary infections in the HLA matched group was lower than in the two HLA mismatched groups (26.67%, 52.78%, and 41.18%, P = 0.035). The cumulative incidence of 100-day and 2-year transplantation related mortality (TRM) in two HLA loci mismatched group was higher than in the HLA matched group and in the one HLA locus mismatched group, (8.4%, 11.8% and 33.3%, P = 0.016) and (12.3%, 18.7% and 47.5%, P = 0.002).</p><p><b>CONCLUSIONS</b>HLA mismatch will not significantly impact the engraftment or 2-year survival after UR-PBSCT, but two mismatched HLA loci may increase the cumulative incidence of severe aGVHD and TRM.</p>