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Parmar G, Seftel MD, Ganz K, Blake J, Holovati JL, Allan DS. Optimizing Access to Unrelated Donors in Canada: Re-Examining the Importance of Donor Factors on Outcomes Following Hematopoietic Cell Transplantation. Curr Oncol 2024; 31:2542-2551. [PMID: 38785471 PMCID: PMC11119328 DOI: 10.3390/curroncol31050190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/17/2024] [Accepted: 04/21/2024] [Indexed: 05/25/2024] Open
Abstract
HLA-matched allogeneic hematopoietic cell transplantation (HCT) is a curative therapy for many patients. Unrelated HLA-matched donors are the most frequently used donor for HCT. When more than one donor transplant option is available, transplant centers can select donors based on non-HLA factors. With improved ability to prevent and treat immune complications, such as graft-versus-host disease and infections, it may be possible to proceed more often using HLA-mismatched donors, allowing greater consideration of non-HLA factors, such as donor age, CMV serostatus, and ABO blood group matching, which have demonstrated important impacts on transplant outcomes. Additional factors to consider are donor availability rates and the usage of domestic donors to optimize outcomes. A review of non-HLA factors and considerations on the selection of optimal unrelated donors for HCT are provided within this updated current context.
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Affiliation(s)
- Gaganvir Parmar
- Stem Cells, Canadian Blood Services, Ottawa, ON K1Z 7M3, Canada (J.B.); (J.L.H.)
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Matthew D. Seftel
- Stem Cells, Canadian Blood Services, Ottawa, ON K1Z 7M3, Canada (J.B.); (J.L.H.)
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V1Y 1T3, Canada
| | - Kathy Ganz
- Stem Cells, Canadian Blood Services, Ottawa, ON K1Z 7M3, Canada (J.B.); (J.L.H.)
| | - John Blake
- Stem Cells, Canadian Blood Services, Ottawa, ON K1Z 7M3, Canada (J.B.); (J.L.H.)
- Department of Industrial Engineering, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Jelena L. Holovati
- Stem Cells, Canadian Blood Services, Ottawa, ON K1Z 7M3, Canada (J.B.); (J.L.H.)
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - David S. Allan
- Stem Cells, Canadian Blood Services, Ottawa, ON K1Z 7M3, Canada (J.B.); (J.L.H.)
- Department of Medicine and Biochemistry, Microbiology & Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada
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Valatkaite-Rakstiene B, Cekauskiene R, Zvirblis T, Jakubauskas A. Reduced human leukocyte antigen mismatching is associated with more favourable outcomes after unrelated donor haematopoietic stem cell transplantation. Int J Immunogenet 2024; 51:63-71. [PMID: 38183417 DOI: 10.1111/iji.12651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/08/2023] [Accepted: 12/24/2023] [Indexed: 01/08/2024]
Abstract
The patient-donor human leukocyte antigen (HLA) match remains the most important prognostic factor for successful unrelated donor haematopoietic stem cell transplantation (UD-HSCT). This single-centre study comprised 125 adult patients with malignant haematological diseases undergoing their first UD-HSCT. The primary goal of this study was to validate the impact of HLA matching on HSCT outcomes, specifically at the HLA-DPB1 and HLA-DRB3/4/5 loci. A multivariable Cox regression analysis with a backward selection algorithm was employed to assess the associations of selected prognostic factors with outcomes after UD-HSCT. Any HLA locus mismatch was found to be associated with an increased incidence of grade II-IV acute graft versus host disease (aGvHD) at 100 days (p = .031; hazard ratio [HR] 1.935) and 6 months (p = .004; HR 2.284) after HSCT. The results of the following analyses also confirmed the strong impact of HLA-DPB1-only mismatch on the incidence of grade II-IV aGvHD at 100-day (p = .006; HR 2.642) as well as at 6-month (p = .007; HR 2.401) time periods. The HLA-DPB1-only mismatch was also shown to be statistically significantly associated with lower relapse incidence (p = .034; HR 0.333). The impact of the HLA-DRB3/4/5 mismatch on outcomes was inconclusive, though the two and more HLA-DPB1 + DRB3/4/5-only mismatches showed a trend towards worse outcomes than a single mismatch. Based on our findings and those of more comprehensive studies, the extended HLA loci typing of patients and donors is suggested to avoid unexpected HLA mismatches during the UD selection.
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Affiliation(s)
- Beatrice Valatkaite-Rakstiene
- State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Hematology, Oncology and Transfusion Medicine Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Rita Cekauskiene
- State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Hematology, Oncology and Transfusion Medicine Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Tadas Zvirblis
- Department of Human and Medical Genetics, Institute of Biomedical sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arturas Jakubauskas
- State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Hematology, Oncology and Transfusion Medicine Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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Cornillon J, Crocchiolo R, Dubois V, Guidicelli G, Jorge-Cordeiro D, Meunier MC, Michiels S, Timmermans A, Villemonteix J, Yakoub-Agha I, Ahmad I. [Unrelated donor selection for allogeneic hematopoietic stem cell transplantation: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2024; 111:S1-S13. [PMID: 37690877 DOI: 10.1016/j.bulcan.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 09/12/2023]
Abstract
The selection of a donor is an essential element in allogeneic hematopoietic stem cell transplantation. In the absence of an HLA-matched related donor, the selection of an unrelated donor is considered, and is currently the most common type of allogenic donor used in practice. Many criteria are considered for the selection when multiple donors are available, particularly in case of partial match. The aim of this workshop is to assist in the selection of an unrelated donor, in keeping with recent data from the literature.
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Affiliation(s)
- Jérôme Cornillon
- Centre hospitalo-universitaire de Saint-Étienne 42, département d'hématologie et de thérapie cellulaire, Saint-Étienne, France.
| | | | | | | | - Debora Jorge-Cordeiro
- Université Paris-Cité, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Saint-Louis, laboratoire d'immunologie, Paris, France
| | - Marie-Christine Meunier
- Hôpital Maisonneuve-Rosemont, Optilab-CHUM, laboratoire de diagnostic moléculaire et cytogénétique, Montréal, Québec, Canada
| | - Sandra Michiels
- Hôpital universitaire de Bruxelles, institut Jules-Bordet, unité de transplantation-hématologie, Bruxelles, Belgique
| | - Aurélie Timmermans
- Hôpital universitaire de Bruxelles, institut Jules-Bordet, unité de transplantation-hématologie, Bruxelles, Belgique
| | - Juliette Villemonteix
- Université Paris-Cité, Assistance publique-Hôpitaux de Paris (AP-HP), hôpital Saint-Louis, laboratoire d'immunologie, Paris, France
| | - Ibrahim Yakoub-Agha
- CHU de Lille, Inserm U1286, Infinite, université de Lille, 59000 Lille, France
| | - Imran Ahmad
- Université de Montréal, hôpital Maisonneuve-Rosemont, institut universitaire d'hématologie-oncologie & de thérapie cellulaire, Montréal, Québec, Canada
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Cornaby C, Weimer ET. Utilizing principal component analysis in the identification of clinically relevant changes in patient HLA single antigen bead solid phase testing patterns. PLoS One 2023; 18:e0288743. [PMID: 37883384 PMCID: PMC10602234 DOI: 10.1371/journal.pone.0288743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/04/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND HLA antibody testing is essential for successful solid-organ allocation, patient monitoring post-transplant, and risk assessment for both solid-organ and hematopoietic transplant patients. Luminex solid-phase testing is the most common method for identifying HLA antibody specificities, making it one of the most complex immunoassays as each panel contains over 90 specificities for both HLA class I and HLA class II with most of the analysis being performed manually in the vendor-provided software. Principal component analysis (PCA), used in machine learning, is a feature extraction method often utilized to assess data with many variables. METHODS & FINDINGS In our study, solid organ transplant patients who exhibited HLA donor-specific antibodies (DSAs) were used to characterize the utility of PCA-derived analysis when compared to a control group of post-transplant and pre-transplant patients. ROC analysis was utilized to determine a potential threshold for the PCA-derived analysis that would indicate a significant change in a patient's single antigen bead pattern. To evaluate if the algorithm could identify differences in patterns on HLA class I and HLA class II single antigen bead results using the optimized threshold, HLA antibody test results were analyzed using PCA-derived analysis and compared to the clinical results for each patient sample. The PCA-derived algorithm had a sensitivity of 100% (95% CI, 73.54%-100%), a specificity of 75% (95% CI, 56.30%-92.54%), with a PPV of 65% (95% CI, 52.50%-83.90%) and an NPV of 100%, in identifying new reactivity that differed from the patients historic HLA antibody pattern. Additionally, PCA-derived analysis was utilized to assess the potential over-reactivity of single antigen beads for both HLA class I and HLA class II antibody panels. This assessment of antibody results identified several beads in both the HLA class I and HLA class II antibody panel which exhibit over reactivity from 2018 to the present time. CONCLUSIONS PCA-derived analysis would be ideal to help automatically identify patient samples that have an HLA antibody pattern of reactivity consistent with their history and those which exhibit changes in their antibody patterns which could include donor-specific antibodies, de novo HLA antibodies, and assay interference. A similar method could also be applied to evaluate the over-reactivity of beads in the HLA solid phase assays which would be beneficial for lot comparisons and instructive for transplant centers to better understand which beads are more prone to exhibiting over-reactivity and impact patient care.
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Affiliation(s)
- Caleb Cornaby
- Histocompatibility & Diagnostic Immunology Laboratory, Children's Hospital of Los Angeles, Los Angeles, California, United States of America
- Department of Pathology and Laboratory Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, United States of America
| | - Eric T Weimer
- Molecular Immunology Laboratory, McLendon Clinical Laboratories, UNC Health, Chapel Hill, North Carolina, United States of America
- Department of Pathology & Laboratory Medicine, the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
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Moyer AM, Hashmi SK, Kroning CM, Patnaik M, Litzow M, Gastineau DA, Hogan WJ, Jacob EK, Kreuter JD, Wakefield LL, Gandhi MJ. Clinical impact of KIR haplotypes in 10/10 HLA-matched unrelated donor-recipient pairs undergoing allogeneic hematopoietic stem cell transplantation. Leuk Lymphoma 2023; 64:671-678. [PMID: 36448323 DOI: 10.1080/10428194.2022.2151838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
To evaluate the impact of killer immunoglobulin-like receptor (KIR) genotyping in allogeneic hematopoietic stem cell transplantation for myeloid disorders at our institution, retrospective KIR genotyping was performed on 77 patients and their 10/10 matched unrelated donors. In a multivariate model including donor age, HLA-DPB1 permissiveness, and presence of donor KIR B/x, an association with overall survival was observed (p = .047). Within the model, increasing donor age increased risk (RR 1.03 [1.00-1.06]/year, p = .046), while donor KIR and HLA-DPB1 permissiveness were not associated with risk (RR 0.51 [0.26-1.03] and RR 0.68 [0.34-1.36]). Grouping recipients by conditioning regimen or limiting the analysis to recipients of peripheral blood stem cells, no association between donor KIR and survival or relapse was identified. No significant associations were observed between overall survival, relapse, grade III-IV acute, or chronic graft versus host disease and presence of KIR B (B/x), quantity of donor KIR B haplotype motifs, or centromeric KIR type (all p > .05).
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Affiliation(s)
- Ann M Moyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Cynthia M Kroning
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Dennis A Gastineau
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | - Eapen K Jacob
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Justin D Kreuter
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Laurie L Wakefield
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Manish J Gandhi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Philogene MC. Histocompatibility and hematopoietic stem cell transplantation. Hum Immunol 2022; 83:663-664. [PMID: 36041911 DOI: 10.1016/j.humimm.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mary Carmelle Philogene
- Histocompatibility Laboratory Services, American Red Cross, Penn-Jersey Region, Philadelphia, PA, United States.
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Timofeeva OA, Philogene MC, Zhang QJ. Current donor selection strategies for allogeneic hematopoietic cell transplantation. Hum Immunol 2022; 83:674-686. [PMID: 36038413 DOI: 10.1016/j.humimm.2022.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 12/27/2022]
Abstract
Since the first allogeneic hematopoietic stem cell transplantation (HCT) was performed by Dr. E. Donnall Thomas in 1957, the field has advanced with new stem cell sources, immune suppressive regimens, and transplant protocols. Stem cells may be collected from bone marrow, peripheral or cord blood from an identical twin, a sibling, or a related or unrelated donor, which can be human leukocyte antigen (HLA) matched, mismatched, or haploidentical. Although HLA matching is one of the most important criteria for successful allogeneic HCT (allo-HCT) to minimize graft vs host disease (GVHD), prevent relapse, and improve overall survival, the novel immunosuppressive protocols for GVHD prophylaxis offered improved outcomes in haploidentical HCT (haplo-HCT), expanding donor availability for the majority of HCT candidates. These immunosuppressive protocols are currently being tested with the HLA-matched and mismatched donors to improve HCT outcomes further. In addition, fine-tuning the DPB1 mismatching and discovering the B leader genotype and mismatching may offer further optimization of donor selection and transplant outcomes. While the decision about a donor type largely depends on the patient's characteristics, disease status, and the transplant protocols utilized by an individual transplant center, there are general approaches to donor selection dictated by donor-recipient histocompatibility and the urgency for HCT. This review highlights recent advances in understanding critical factors in donor selection strategies for allo-HCT. It uses clinical vignettes to demonstrate the importance of making timely decisions for HCT candidates.
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Affiliation(s)
- Olga A Timofeeva
- Department of Pathology and Laboratory Medicine, MedStar Georgetown University Hospital, Georgetown University School of Medicine, Georgetown University Medical Center, Washington, DC 20007, United States.
| | - Mary Carmelle Philogene
- Histocompatibility Laboratory Services, American Red Cross, Penn-Jersey Region, Philadelphia, PA 19123, United States.
| | - Qiuheng Jennifer Zhang
- UCLA Immunogenetics Center, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles 90095, United States.
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