HLA haploidentical stem cell transplantation from HLA homozygous donors to HLA heterozygous donors may have lower survival rates than haploidentical transplantation from HLA heterozygous donors to HLA heterozygous donors: a retrospective nationwide analysis.
Keiko FukunagaKazuhiro IkegameHirohisa NakamaeNoriko DokiTakahiro FukudaYukio KondoTakahide AraTetsuya EtoYasuo MoriKen-Ichi MatsuokaYoshinobu KandaMakoto OnizukaYoshiko AtsutaTatsuo IchinoheSatoko MorishimaJunya Kandanull nullPublished in: International journal of hematology (2024)
In HLA haploidentical stem cell transplantation, patients and donors usually share one HLA haplotype and have one different HLA haplotype (hetero-to-hetero). However, there are rare cases of transplantation from HLA homozygous donors to heterozygous recipients (homo-to-hetero), resulting in mismatches only in the graft-versus-host direction. We previously reported that homo-to-hetero transplants have a lower survival rate in a mouse model than hetero-to-hetero transplants due to stronger graft-versus-host disease (GVHD) but inferior graft-versus-leukemia effect. To examine whether homo-to-hetero transplant effects also occur in humans, we retrospectively compared the results of 59 homo-to-hetero and 4,539 hetero-to-hetero cases in the Japanese transplant registry data. The results showed no statistical difference between the homo-to-hetero and hetero-to-hetero groups in the cumulative incidences of neutrophil engraftment (83.1% vs 89.0%), acute GVHD II-IV (36.8% vs 38.8%), III-IV (16.8% vs 17.4%), chronic GVHD (32.7% vs 30.7%), relapse (52.9% vs 49.0%), and non-relapse mortality (31.6% vs 28.2%). In contrast, overall survival was significantly lower in the homo-to-hetero group than in the hetero-to-hetero group (12.6% vs 26.2%, p = 0.0308). The inferior effect of homo-to-hetero transplantation on overall survival remained significant in multivariate analyses.
Keyphrases
- stem cell transplantation
- high dose
- mouse model
- end stage renal disease
- chronic kidney disease
- magnetic resonance
- kidney transplantation
- computed tomography
- peripheral blood
- cardiovascular disease
- magnetic resonance imaging
- stem cells
- ejection fraction
- acute lymphoblastic leukemia
- coronary artery disease
- liver failure
- low dose
- mesenchymal stem cells
- newly diagnosed
- peritoneal dialysis
- intensive care unit
- cell therapy
- contrast enhanced
- patient reported