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Heinemann FM, Baumgart C, Binder C, Börger V, Fischer JC, Heinold A, Jiménez Klingberg C, Lenz V, Riebschläger S, Zeiler T, Horn PA, Kordelas L. Recruiting refugees and migrants as potential hematopoietic stem cell donors to serve patients of comparable ethnicities with rare human leucocyte antigen patterns - The BluStar.NRW project in North Western Germany. Transpl Immunol 2024; 82:101985. [PMID: 38184211 DOI: 10.1016/j.trim.2024.101985] [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: 09/15/2023] [Revised: 12/12/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
Currently, approximately 19 million people with a migration background live in Germany. The majority of those descend from regions where the population has a genetically different distribution of HLA antigens when compared to the HLA frequencies usually found in North Western Europe. In case of severe haematological disorders of these individuals, allogeneic stem cell transplantation may be the treatment of choice. However, finding appropriate histocompatible hematopoietic stem cell donors continues to be a major challenge. If no matching sibling donors are available, there are only few suitable donors with a similar genetic background available in international blood stem cell donor registries. The "BluStar.NRW" project aimed to recruit new blood and hematopoietic stem cell donors with a migration background and to noticeably increase the number of suitable donors for patients within this group. Since December 2017, a total number of 9100 blood and stem cell donors with a migration background were recruited and typed for this project. HLA typing for HLA-A, -B, -C, -DRB1, -DQB1, and -DPB1 was performed by Next Generation Sequencing. We assessed the proportion of rare alleles according to HLA frequency tables, as defined by a frequency of <1:1000. The rare HLA allele frequencies according to HLA frequency tables of the BluStar.NRW cohort were compared with a matched control donor cohort: Rare HLA-A, -B, -C, -DRB1 and -DQB1 alleles occurred three times more frequent than in the control group, but rare HLA-DPB1 alleles occurred more frequently in the control cohort. This difference was highly significant for all HLA alleles (p < 0.0001 for HLA-A, -B, -C, -DRB1, -DPB1; p = 0.0002 for HLA-DQB1). In addition, the distribution of rare alleles differed between the two groups. To date, 29 work-ups were initiated, 12 PBSC, one BM and three DLI were collected so far out of the BluStar.NRW cohort. The apheresis probability is twofold higher (0.18% vs. 0.07%) compared to the control group which clearly shows a serious medical need. However, 13 work-ups were cancelled in the BluStar.NRW donor cohort which represents an almost twice as higher cancellation rate (45% vs. 25%). This single registry analysis with a large sample cohort clearly indicates that hematopoietic stem cell donors with a migration background represent an adequate donor pool to serve patients of comparable ethnicity.
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Affiliation(s)
- F M Heinemann
- Institute for Transfusion Medicine, University Hospital, University Medicine Essen, Germany.
| | - C Baumgart
- Institute for Transfusion Medicine, University Hospital, University Medicine Essen, Germany
| | - C Binder
- Westdeutsche SpenderZentrale WSZE, Ratingen, Germany
| | - V Börger
- Institute for Transfusion Medicine, University Hospital, University Medicine Essen, Germany
| | - J C Fischer
- Institute for Transplantation Diagnostics and Cell Therapeutics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Heinold
- Institute for Transfusion Medicine, University Hospital, University Medicine Essen, Germany
| | - C Jiménez Klingberg
- German Red Cross Blood Service West, Hagen, Breitscheid, Münster and Bad-Salzuflen, Germany
| | - V Lenz
- Institute for Transfusion Medicine, University Hospital, University Medicine Essen, Germany
| | - S Riebschläger
- Institute for Transfusion Medicine, University Hospital, University Medicine Essen, Germany
| | - T Zeiler
- German Red Cross Blood Service West, Hagen, Breitscheid, Münster and Bad-Salzuflen, Germany
| | - P A Horn
- Institute for Transfusion Medicine, University Hospital, University Medicine Essen, Germany
| | - L Kordelas
- Westdeutsche SpenderZentrale WSZE, Ratingen, Germany; Clinic for Hematology and Stem Cell Transplantation, University Medicine Essen, Essen, Germany
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Grubic Z, Maskalan M, Stingl Jankovic K, Burek Kamenaric M, Zunec R. An intermediate-sized donor registry experience: HLA barriers in matching procedures. HLA 2024; 103:e15348. [PMID: 38265197 DOI: 10.1111/tan.15348] [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: 08/30/2023] [Revised: 12/18/2023] [Accepted: 01/03/2024] [Indexed: 01/25/2024]
Abstract
The data enabling the estimation of the possibility of finding a matched unrelated donor (MUD) within a relatively short time is important for the success of hematopoietic stem cell transplantation (HSCT). In the present study, 738 unrelated Croatian patients in the program of unrelated HSCT were retrospectively analyzed for gender matching, donor origin (national or international), the distribution of HLA alleles and haplotypes, as well as for the probability of finding a 9-10/10 MUD. Almost 70% of the patients in our study group had a 10/10 MUD, while among the patients with a 9/10 MUD, a 1st field resolution level mismatched donor was selected for 55.0% of patients. The majority of pairs were HLA-A mismatched (33.8%). A comparison of HLA allele frequencies between two subgroups of patients revealed significant differences for 13 alleles. However, after p value correction, the difference in frequency remained significant only for four alleles; three HLA alleles (B*08:01, C*07:01, and DRB1*03:01) demonstrated a significantly higher frequency among patients with a 10/10 MUD (Pcorr < 0.0001, Pcorr = 0.0096, and Pcorr < 0.0001, respectively), while the B*35:08 allele was significantly more present among patients with a 9/10 MUD (Pcorr = 0.0328). The comparison of the distribution of HLA haplotypes between patients with a 10/10 MUD and patients with a 9/10 MUD showed significant differences for a number of two-locus and three-locus haplotypes, as well as for one five-locus haplotype (HLA-A*01:01~B*08:01~C*07:01~DRB1*03:01~DQB1*02:01), which was significantly more present in the group of patients with a 10/10 MUD. At least one HLA haplotype from the group of non-frequent HLA haplotypes (positions >1000) was carried by patients with a 9/10 MUD. The data obtained by the present study will contribute to a better estimation of the probability of finding a suitable 9-10/10 MUD for Croatian patients in need of HSCT.
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Affiliation(s)
- Zorana Grubic
- Tissue Typing Centre, Clinical Department for Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marija Maskalan
- Tissue Typing Centre, Clinical Department for Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Katarina Stingl Jankovic
- Tissue Typing Centre, Clinical Department for Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marija Burek Kamenaric
- Tissue Typing Centre, Clinical Department for Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Renata Zunec
- Tissue Typing Centre, Clinical Department for Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
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Grubic Z, Maskalan M, Burek Kamenaric M, Desnica L, Mikulic M, Stingl Jankovic K, Durakovic N, Serventi Seiwerth R, Vrhovac R, Zunec R. Alternative donor strategy in unrelated hematopoietic stem cell transplantation - outcome with mismatched donors. Adv Med Sci 2023; 68:332-340. [PMID: 37741003 DOI: 10.1016/j.advms.2023.09.003] [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: 12/14/2022] [Revised: 04/06/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE This study retrospectively investigated the association between the level of human leukocyte antigen (HLA) mismatches (MMs), direction of disparities and differences at particular HLA locus on clinical outcomes of hematopoietic stem cell transplantation (HSCT). Investigated outcomes were overall survival (OS) and disease-free survival (DFS), graft-versus-host disease (GvHD), relapse and non-relapse mortality (NRM). PATIENTS AND METHODS Study cohort included 108 adult patients transplanted between 2011 and 2021 and their 9/10 mismatched unrelated donors (MMUD). All individuals were typed for HLA-A, -B, -C, -DRB1, -DQB1 and -DPB1 loci using Polymerase Chain Reaction-Sequence Specific Primers, PCR-Sequence Based Typing and Next-Generation Sequencing. All statistical analyses were done in the MedCalc software, version 19.2.6. RESULTS Patients with MMs at HLA-B locus demonstrated worse OS (P = 0.0440, HR = 2.00, n = 20). Absence of HLA-DRB5 was associated with a higher incidence of GvHD (P = 0.0112, HR = 1.93, n = 67). A lower incidence of GvHD was observed in patients with HLA class II MMs compared to patients with HLA class I MMs (P = 0.0166, HR = 1.94, n = 29). Finally, analysis of PIRCHE score (PS) impact revealed that patients with HLA class II PS > 10 in GvH direction showed higher incidence of GvHD compared to patients with HLA class II PS < 10 (P = 0.0073, HR = 2.01, n = 55). CONCLUSION Obtained results undisputedly indicate the necessity to further investigate this matter on a larger patient group, with focus on specific HLA alleles to define precisely priority criteria for selecting the best donor for all patients, thus improving the outcome of HSCT with an MMUD.
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Affiliation(s)
- Zorana Grubic
- Tissue Typing Centre, Clinical Department for Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia.
| | - Marija Maskalan
- Tissue Typing Centre, Clinical Department for Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marija Burek Kamenaric
- Tissue Typing Centre, Clinical Department for Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Lana Desnica
- Department of Hematology, Internal Clinic, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mirta Mikulic
- Department of Hematology, Internal Clinic, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Katarina Stingl Jankovic
- Tissue Typing Centre, Clinical Department for Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Nadira Durakovic
- Department of Hematology, Internal Clinic, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ranka Serventi Seiwerth
- Department of Hematology, Internal Clinic, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Radovan Vrhovac
- Department of Hematology, Internal Clinic, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Renata Zunec
- Tissue Typing Centre, Clinical Department for Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
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Ponvilawan B, Owattanapanich W, Charoenngam N, Kungwankiattichai S. Effects of different types of allogeneic hematopoietic stem cell transplantation donors on Philadelphia chromosome-positive acute lymphoblastic leukemia during the tyrosine kinase inhibitor era: A systematic review and meta-analysis. Hematol Oncol Stem Cell Ther 2023; 16:197-208. [PMID: 34743893 DOI: 10.1016/j.hemonc.2021.09.007] [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: 06/14/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Matched donor (MD) allogeneic hematopoietic stem cell transplantation (allo-HSCT) is currently the preferred choice of treatment for Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) patients who have achieved complete remission. This systematic review and meta-analysis was conducted to investigate the effects of allo-HSCTs from different donor types for Ph+ ALL patients who received tyrosine kinase inhibitors (TKIs). METHODS Studies in EMBASE and MEDLINE between inception and December 2020 were identified using search terms related to "Ph+ ALL" and "HSCT." Eligible studies were studies with Ph+ ALL patients who received a TKI and allo-HSCT. The primary outcomes of interest-the overall survival (OS) or relapse-free survival (RFS)-needed to be reported. The Mantel-Haenszel method was used to combine the effect estimates and associated 95% confidence intervals (CIs) of each donor type. RESULTS Fourteen cohort studies were identified for the meta-analysis. Haploidentical (HID)-HSCT for Ph+ ALL patients resulted in a superior RFS to MD-HSCT, with a pooled odds ratio (OR) of 1.57 (95% CI, 1.05-2.32; I2 = 0%). However, HID-HSCT and MD-HSCT had comparable OS. Furthermore, HID-HSCT group had a significantly lower relapse rate than MD-HSCT group. On the other hand, the risks of graft-versus-host disease (GvHD) were higher for HID-HSCT and pooled OR of chronic GvHD rate. The OS and RFS of matched sibling-HSCT, matched unrelated-HSCT, and cord blood-HSCT were comparable with those of HID-HSCT. CONCLUSION This systematic review and meta-analysis showed that HID-HSCT is as effective as MD-HSCT in Ph+ ALL patients.
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Affiliation(s)
- Ben Ponvilawan
- Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Weerapat Owattanapanich
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nipith Charoenngam
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Smith Kungwankiattichai
- Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Seo S, Usui Y, Matsuo K, Atsuta Y, Igarashi A, Fukuda T, Ozawa Y, Katayama Y, Yoshida S, Uchida N, Kondo T, Kako S, Tsukada N, Kato S, Onizuka M, Ichinohe T, Kimura F, Kanda Y, Miyamura K, Kanda J. Impact of the combination of donor age and HLA disparity on the outcomes of unrelated bone marrow transplantation. Bone Marrow Transplant 2021; 56:2410-2422. [PMID: 33990702 DOI: 10.1038/s41409-021-01289-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 11/09/2022]
Abstract
Impact of donor age considering HLA disparity on hematopoietic cell transplantation (HCT) outcomes has not been fully evaluated. We evaluated 8486 patients who received unrelated bone marrow transplantation (UR-BMT) from 8/8 or 7/8 HLA-matched donors. Compared to 8/8 HLA-matched younger donors (<40 years), 8/8 HLA-matched older donors (subdistribution hazard ratio [SHR], 1.16; 95% CI, 0.97-1.38) and 7/8 HLA-matched younger donors (SHR, 1.33; 95% CI, 1.11-1.58) were associated with increased risk of grade III-IV acute graft-versus-host disease (aGVHD). 7/8 HLA-matched older donors had further increased risk (SHR, 2.00; 95% CI, 1.68-2.38) due to interaction between donor age and HLA disparity (p for interaction = 0.038). Progression-free survival (PFS) after UR-BMT with 8/8 HLA-matched younger donors was comparable to that after UR-BMT with 8/8 HLA-matched older donors, whereas UR-BMT with 7/8 HLA-matched younger or older donors was significantly associated with lower PFS than UR-BMT with 8/8 HLA-matched younger donors (younger donor; HR, 1.12; 95% CI, 1.04-1.21, older donor; HR, 1.28; 95% CI, 1.17-1.40; p for interaction = 0.079). In conclusion, adverse effect of increased donor age requires attention, especially in HLA-mismatched UR-BMT due to interaction between donor age and HLA disparity. Intensive aGVHD prophylaxis may be required to improve outcomes after HCT with mismatched older donors.
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Affiliation(s)
- Sachiko Seo
- Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan.
| | - Yoshiaki Usui
- Division of Cancer Information and Control, Aichi Cancer Center Research Institute, Aichi, Japan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Aichi, Japan.,Department of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Aichi, Japan.,Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Aiko Igarashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Yukiyasu Ozawa
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Yuta Katayama
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Shuro Yoshida
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Naoyuki Uchida
- Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations, Toranomon Hospital, Tokyo, Japan
| | - Tadakazu Kondo
- Department of Hematology and Oncology, Kyoto University, Kyoto, Japan
| | - Shinichi Kako
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Nobuhiro Tsukada
- Department of Hematology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Shunichi Kato
- Department of Innovative Medical Science, Tokai University School of Medicine, Kanagawa, Japan
| | - Makoto Onizuka
- Department of Hematology/Oncology, Tokai University School of Medicine, Kanagawa, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Fumihiko Kimura
- Division of Hematology, National Defense Medical College, Tokorozawa, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University, Tochigi, Japan
| | - Koichi Miyamura
- Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Junya Kanda
- Department of Hematology and Oncology, Kyoto University, Kyoto, Japan
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Chances of Finding Matched Unrelated Donors for Saudi Patients in Need of Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2021; 27:423.e1-423.e7. [PMID: 33781751 DOI: 10.1016/j.jtct.2021.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 11/22/2022]
Abstract
Finding HLA-matched donors for patients in need of hematopoietic stem cell transplantation (HSCT) stands a better chance in their own ethnic group. This information led many nations to establish unrelated stem cell donor registries. We started our Saudi Stem Cell Donor registry (SSCDR) in 2011. The calculated donor pool size was nearly 1 million donors to find a matched donor for every patient. So far we have recruited 75,145 donors. In this exercise we attempted to investigate the chances of finding a matched donor for Saudi patients in need of HSCT. A total of 445 patients were recruited for this study. Donor searches were carried out locally and internationally using Prometheus software and World Marrow Donor Association Search and Match Service, respectively. Only 24% of the patients found a matched donor in our registry, 12% found a donor in other registries, making it a total of 36% of our patients who have the chance to find a full 10/10 HLA-matched donor. However, when we included 9/10 and 8/10 with the full matched donors, the chances go up to 83%. The top scoring registries for number of patients finding 10/10 matched donors were SSCDR (108), Deutsche Stammzellspenderdatei Nabelschnurblut (n = 52), King Faisal Specialist Hospital & Research Centre Stem Cell Donor Registry (n = 52), NMDP-National Marrow Donor Program/Be The Match (n = 43), TURKOK-Turkish Stem Cell Coordination Centre (n = 39), DKMS United Kingdom (n = 24), and Ezer Mizion Bone Marrow Donor Registry (n = 20). The patient who found the highest number of donors in international registries carried the European haplotype A1-B8-DR3; a total of 272 donors were found, and none of them were from our registry. Patients with the highest matched donor numbers in SSCDR carried haplotypes that were not common in international registries. Having a local registry increases the chances of finding a matched donor for our patients; however, international registries can still add to the chances of finding matched donors. Increasing our donor pool will increase chances of our patients finding a matched donor.
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Nunes K, Aguiar VRC, Silva M, Sena AC, de Oliveira DCM, Dinardo CL, Kehdy FSG, Tarazona-Santos E, Rocha VG, Carneiro-Proietti ABF, Loureiro P, Flor-Park MV, Maximo C, Kelly S, Custer B, Weir BS, Sabino EC, Porto LC, Meyer D. How Ancestry Influences the Chances of Finding Unrelated Donors: An Investigation in Admixed Brazilians. Front Immunol 2020; 11:584950. [PMID: 33240273 PMCID: PMC7677137 DOI: 10.3389/fimmu.2020.584950] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022] Open
Abstract
A match of HLA loci between patients and donors is critical for successful hematopoietic stem cell transplantation. However, the extreme polymorphism of HLA loci - an outcome of millions of years of natural selection - reduces the chances that two individuals will carry identical combinations of multilocus HLA genotypes. Further, HLA variability is not homogeneously distributed throughout the world: African populations on average have greater variability than non-Africans, reducing the chances that two unrelated African individuals are HLA identical. Here, we explore how self-identification (often equated with "ethnicity" or "race") and genetic ancestry are related to the chances of finding HLA compatible donors in a large sample from Brazil, a highly admixed country. We query REDOME, Brazil's Bone Marrow Registry, and investigate how different criteria for identifying ancestry influence the chances of finding a match. We find that individuals who self-identify as "Black" and "Mixed" on average have lower chances of finding matches than those who self-identify as "White" (up to 57% reduction). We next show that an individual's African genetic ancestry, estimated using molecular markers and quantified as the proportion of an individual's genome that traces its ancestry to Africa, is strongly associated with reduced chances of finding a match (up to 60% reduction). Finally, we document that the strongest reduction in chances of finding a match is associated with having an MHC region of exclusively African ancestry (up to 75% reduction). We apply our findings to a specific condition, for which there is a clinical indication for transplantation: sickle-cell disease. We show that the increased African ancestry in patients with this disease leads to reduced chances of finding a match, when compared to the remainder of the sample, without the condition. Our results underscore the influence of ancestry on chances of finding compatible HLA matches, and indicate that efforts guided to increasing the African component of registries are necessary.
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Affiliation(s)
- Kelly Nunes
- Laboratory of Evolutionary Genetics, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - Vitor R. C. Aguiar
- Laboratory of Evolutionary Genetics, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - Márcio Silva
- Instituto de Matemática e Estatística, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alexandre C. Sena
- Instituto de Matemática e Estatística, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Danielli C. M. de Oliveira
- Registro Nacional de Doadores Voluntários de Medula Óssea—REDOME, Instituto Nacional do Câncer, Ministério da Saúde, Rio de Janeiro, Brazil
| | | | | | - Eduardo Tarazona-Santos
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Vanderson G. Rocha
- Fundação Pró Sangue, Hemocentro de São Paulo, São Paulo, Brazil
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Paula Loureiro
- Fundação Hemominas, Belo Horizonte, Brazil
- Fundação de Hematologia e Hemoterapia de Pernambuco, HEMOPE, Recife, Brazil
| | - Miriam V. Flor-Park
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto da Criança, São Paulo, Brazil
| | | | - Shannon Kelly
- Epidemiology, Vitalant Research Institute, San Francisco, CA, United States
- University of California San Francisco Benioff Children’s Hospital Oakland, Oakland, CA, United States
| | - Brian Custer
- Epidemiology, Vitalant Research Institute, San Francisco, CA, United States
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Bruce S. Weir
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Ester C. Sabino
- Instituto de Medicina Tropical, Departamento de Moléstias Infecciosas e Parasitárias da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luís Cristóvão Porto
- Laboratório de Histocompatibilidade e Criopreservação, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diogo Meyer
- Laboratory of Evolutionary Genetics, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
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8
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Nicoloso G, Kürsteiner O, Bussmann F, Marbacher M, Tiercy JM. A study of selected hematopoietic stem cell donors provided by an intermediate size registry. Eur J Haematol 2019; 103:426-432. [PMID: 31385372 DOI: 10.1111/ejh.13307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/25/2019] [Accepted: 07/27/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Planning new hematopoietic stem cell (HSC) donor recruitment strategies requires a sound understanding of the factors underlying donor selection, especially considering HLA-matching criteria. METHOD A total of 182 consecutive workups of Swiss donors performed from 2014 to 2017 were analyzed for HLA match level, locus disparities, number of potentially 10/10 matched donors in the international database, donor ranking on the lists, donor date of registration, age, ABO, CMV, gender matching, patient genotype frequency, and country performing the search. RESULTS Matching status of the selected donors was 10/10 for 38.5%, 10-12/12 for 35.1%, and 8-9/10 for 26.4% donors, without differences in average donor age in the three categories. HLA-A and -C mismatches were most frequent and -DRB1 very rare. 8.2% patients were matched for HLA-DPB1 (12/12). ABO matching was 46.3%, and CMV matching was 59.1%. Based on "HaploStat"-derived genotype frequencies, 50.3% patients belonged to the "good," 38.5% to the "fair," and 11.2% to the "poor" search prognosis categories. 37.9% of transplants were gender-mismatched, and 42.3% of donors were female. CONCLUSION HLA typing quality (high resolution, all loci typed), great diversity of haplotypes and donor age are main factors impacting the selection of Swiss donors, while gender and ABO matching seem to be of secondary importance.
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Affiliation(s)
- Grazia Nicoloso
- Swiss Blood Stem Cells, Swiss Transfusion SRC Ltd, Bern, Switzerland
| | - Oliver Kürsteiner
- Swiss Blood Stem Cells, Swiss Transfusion SRC Ltd, Bern, Switzerland
| | - Felix Bussmann
- Swiss Blood Stem Cells, Swiss Transfusion SRC Ltd, Bern, Switzerland
| | - Monika Marbacher
- Swiss Blood Stem Cells, Swiss Transfusion SRC Ltd, Bern, Switzerland
| | - Jean-Marie Tiercy
- Swiss Blood Stem Cells, Swiss Transfusion SRC Ltd, Bern, Switzerland
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9
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High-resolution HLA phased haplotype frequencies to predict the success of unrelated donor searches and clinical outcome following hematopoietic stem cell transplantation. Bone Marrow Transplant 2019; 54:1701-1709. [PMID: 30953025 PMCID: PMC7198472 DOI: 10.1038/s41409-019-0520-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/18/2019] [Indexed: 02/06/2023]
Abstract
HLA matching is a critical factor for successful allogeneic hematopoietic stem cell transplantation. For unrelated donor searches, matching is usually based on high-resolution typing at five HLA loci, looking for a 10/10 match. Some studies have proposed that further matching at the haplotype level could be beneficial for clinical outcome. In this study, we determined the phased haplotypes of 291 patients using family members and segregation analysis. The sum of ranks of the haplotypes carried by patients was used as a surrogate predictor of a successful unrelated donor search. The putative impact of haplotypes was then analyzed in a cohort of 211 recipients transplanted with 10/10 matched unrelated donors. A logistic regression analysis showed a highly significant effect of the haplotypes in the outcome of a search, but we did not find any significant effect on overall survival, graft versus host disease or relapse/progression following HSCT. This study provides useful data for the optimization of unrelated bone marrow donor searches, but does not confirm previous reports that matching at the haplotype level has a clinical impact following HSCT. Due to the extreme polymorphism of HLA genes, further studies are warranted to better understand the many factors at play.
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10
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Next Generation Sequencing in HLA haplotype distribution among Telugu speaking population from Andhra Pradesh, India. Hum Immunol 2018; 79:583-584. [PMID: 29890180 DOI: 10.1016/j.humimm.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/22/2018] [Accepted: 05/25/2018] [Indexed: 11/23/2022]
Abstract
HLA A B:C:DRB1:DQB1 allele and haplotype frequencies were determined among India, Andhra Pradesh, Telugu speaking population from South India by Next Generation Sequencing. 180 bone marrow registry donors and 6 cord blood units from Jeevan Stem Cell Foundation (part of Be The Cure Registry), Chennai, Tamilnadu state were included in the study.
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11
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Otegbeye F. Understanding population-wide haplotype frequencies of human leukocyte antigen (HLA) alleles in linkage disequilibrium is important for hematopoietic stem cell transplantation. Rev Bras Hematol Hemoter 2017; 39:187-188. [PMID: 28830592 PMCID: PMC5568582 DOI: 10.1016/j.bjhh.2017.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/03/2017] [Indexed: 01/15/2023] Open
Affiliation(s)
- Folashade Otegbeye
- University Hospitals Cleveland Medical Center/Seidman Cancer Center, Cleveland, United States.
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12
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13
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Romòn I, Montes C, Ligeiro D, Trindade H, Sanchez-Mazas A, Nunes JM, Buhler S. Mapping the HLA diversity of the Iberian Peninsula. Hum Immunol 2016; 77:832-840. [PMID: 27377016 DOI: 10.1016/j.humimm.2016.06.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 01/02/2023]
Abstract
The polymorphism of HLA genes can be used to reconstruct human peopling history. However, this huge diversity impairs successful matching in stem cell transplantation, a situation which has led to the recruitment of millions of donors worldwide. In parallel to the increase of recruitment, registries are progressively relying on information from population genetics to optimize their donor pools in terms of HLA variability. In this study, the HLA data of 65,000 Spanish bone marrow donors were analyzed together with 60,000 Portuguese individuals to provide a comprehensive HLA genetic map of the Iberian Peninsula. The frequencies of many alleles were shown to vary continuously across the Peninsula, either increasing or decreasing from the Mediterranean coast to the Atlantic domain or from the Strait of Gibraltar to the Pyrenees and Bay of Biscay. Similar patterns were observed for several haplotypes. In addition, within some regions neighboring provinces share a close genetic similarity. These results outline the genetic landscape of the Iberian Peninsula, and confirm that the analysis of the HLA polymorphism may reveal relevant signatures of past demographic events even when data from donor registries are used. This conclusion stimulates future developments of the Spanish registry, presented here for the first time.
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Affiliation(s)
- Iñigo Romòn
- Histocompatibility Laboratory, Hematology and Transfusion Service, Hospital Universitario Marqués de Valdecilla - IFIMAV, Santander, Spain.
| | - Carmen Montes
- Histocompatibility Laboratory, Hematology and Transfusion Service, Hospital Universitario Marqués de Valdecilla - IFIMAV, Santander, Spain
| | - Dario Ligeiro
- Lisbon Center for Blood and Transplantation, Instituto Português de Sangue e Transplantação, IP, Lisbon, Portugal
| | - Hélder Trindade
- Lisbon Center for Blood and Transplantation, Instituto Português de Sangue e Transplantação, IP, Lisbon, Portugal
| | - Alicia Sanchez-Mazas
- Laboratory of Anthropology, Genetics and Peopling history (AGP), Department of Genetics and Evolution - Anthropology Unit, University of Geneva, Switzerland; Institute of Genetics and Genomics in Geneva (IGE3), Switzerland
| | - José Manuel Nunes
- Laboratory of Anthropology, Genetics and Peopling history (AGP), Department of Genetics and Evolution - Anthropology Unit, University of Geneva, Switzerland; Institute of Genetics and Genomics in Geneva (IGE3), Switzerland
| | - Stéphane Buhler
- Laboratory of Anthropology, Genetics and Peopling history (AGP), Department of Genetics and Evolution - Anthropology Unit, University of Geneva, Switzerland; Transplantation Immunology Unit and National Reference Laboratory for Histocompatibility (UIT/LNRH), Department of Genetic and Laboratory Medicine, Geneva University Hospitals, Switzerland.
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14
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Tiercy JM. How to select the best available related or unrelated donor of hematopoietic stem cells? Haematologica 2016; 101:680-7. [PMID: 27252513 DOI: 10.3324/haematol.2015.141119] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/09/2016] [Indexed: 11/09/2022] Open
Abstract
Recognition of HLA incompatibilities by the immune system represents a major barrier to allogeneic hematopoietic stem cell transplantation. HLA genotypically identical sibling donors are, therefore, the gold standard for transplantation purposes, but only 30% patients have such a donor. For the remaining 70% patients alternative sources of stem cells are a matched unrelated adult volunteer donor, a haploidentical donor or a cord blood unit. The definition of 'HLA matching' depends on the level of resolution and on which loci are tested. The development of HLA molecular typing technologies and the availability of more than 27 million donors in the international database has greatly facilitated unrelated donor searches. The gold standard is high resolution typing at the HLA-A, -B, -C, -DRB1, and -DQB1 loci (10/10 match). Single disparities for HLA-A, -B, - C, or -DRB1 are associated with increased risk of post-transplant complications, but less so in patients with advanced disease, and in those undergoing T-cell-depleted allografting. HLA-DQB1 mismatches seem to be better tolerated and some HLA-C, -DRB1 and -DPB1 disparities are potentially less immunogenic. HLA typing by next-generation sequencing methods is likely to change matching algorithms by providing full sequence information on all HLA loci in a single step. In most European populations a 10/10 matched donor can be found for at least 50% of patients and an additional 20-30% patients may have a 9/10 matched donor. Genetic factors that help in identifying donors with less immunogenic mismatches are discussed. Haploidentical donors are increasingly used as an alternative source of stem cells for those patients lacking a matched unrelated donor.
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Affiliation(s)
- Jean-Marie Tiercy
- National Reference Laboratory for Histocompatibility, Department of Genetic and Laboratory Medicine, University Hospitals Geneva, Switzerland
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15
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Bochtler W, Gragert L, Patel ZI, Robinson J, Steiner D, Hofmann JA, Pingel J, Baouz A, Melis A, Schneider J, Eberhard HP, Oudshoorn M, Marsh SGE, Maiers M, Müller CR. A comparative reference study for the validation of HLA-matching algorithms in the search for allogeneic hematopoietic stem cell donors and cord blood units. HLA 2016; 87:439-48. [PMID: 27219013 PMCID: PMC5089599 DOI: 10.1111/tan.12817] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 04/19/2016] [Accepted: 04/22/2016] [Indexed: 12/02/2022]
Abstract
The accuracy of human leukocyte antigen (HLA)‐matching algorithms is a prerequisite for the correct and efficient identification of optimal unrelated donors for patients requiring hematopoietic stem cell transplantation. The goal of this World Marrow Donor Association study was to validate established matching algorithms from different international donor registries by challenging them with simulated input data and subsequently comparing the output. This experiment addressed three specific aspects of HLA matching using different data sets for tasks of increasing complexity. The first two tasks targeted the traditional matching approach identifying discrepancies between patient and donor HLA genotypes by counting antigen and allele differences. Contemporary matching procedures predicting the probability for HLA identity using haplotype frequencies were addressed by the third task. In each task, the identified disparities between the results of the participating computer programs were analyzed, classified and quantified. This study led to a deep understanding of the algorithms participating and finally produced virtually identical results. The unresolved discrepancies total to less than 1%, 4% and 2% for the three tasks and are mostly because of individual decisions in the design of the programs. Based on these findings, reference results for the three input data sets were compiled that can be used to validate future matching algorithms and thus improve the quality of the global donor search process.
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Affiliation(s)
- W Bochtler
- Zentrales Knochenmarkspender-Register Deutschland (ZKRD), Ulm, Germany
| | - L Gragert
- National Marrow Donor Program (NMDP), Minneapolis, MN, USA
| | - Z I Patel
- Anthony Nolan Research Institute (ANRI), Royal Free Hospital, London, UK
| | - J Robinson
- Anthony Nolan Research Institute (ANRI), Royal Free Hospital, London, UK.,UCL Cancer Institute, Royal Free Campus, London, UK
| | - D Steiner
- Czech Stem Cells Registry (CSCR) and Department of Cybernetics, Czech Technical University, Prague, Czech Republic
| | - J A Hofmann
- DKMS German Bone Marrow Donor Center, Tübingen, Germany
| | - J Pingel
- DKMS German Bone Marrow Donor Center, Tübingen, Germany
| | - A Baouz
- Agence de la biomedecine - Registre France Greffe de Moelle (FGM), Paris, France
| | - A Melis
- Bone Marrow Donors Worldwide (BMDW) and Europdonor operated by Matchis, Leiden, The Netherlands
| | - J Schneider
- National Marrow Donor Program (NMDP), Minneapolis, MN, USA
| | - H-P Eberhard
- Zentrales Knochenmarkspender-Register Deutschland (ZKRD), Ulm, Germany
| | - M Oudshoorn
- Bone Marrow Donors Worldwide (BMDW) and Europdonor operated by Matchis, Leiden, The Netherlands
| | - S G E Marsh
- Anthony Nolan Research Institute (ANRI), Royal Free Hospital, London, UK.,UCL Cancer Institute, Royal Free Campus, London, UK
| | - M Maiers
- National Marrow Donor Program (NMDP), Minneapolis, MN, USA
| | - C R Müller
- Zentrales Knochenmarkspender-Register Deutschland (ZKRD), Ulm, Germany
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Abstract
For the majority of hematologic malignancies allogeneic hematopoietic cell transplantation (HCT) is the only curative treatment option. Sibling donors have been the standard for adult patients. Since there is not a suitable family donor for all patients, the need for alternative donors for HCT is great. Fortunately, the availability of unrelated volunteer donor registries has expanded over the years and the results of HCT with matched unrelated donors (MUD) are comparable to the results with matched related donors (MRD). Nevertheless, there are many patients lacking a well-matched donor. To increase the applicability of transplantation, alternative donors such as mismatched unrelated donors (MMURD), cord blood stem cell products and haploidentical related donors have been widely used. This review seeks to give insights into the use of MMUD donors for HCT and summarize the existing data.
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Affiliation(s)
- Henning Sebastian Schäfer
- Department of Hematology, Oncology and Stem Cell Transplantation, Albert-Ludwigs University Medical Center, Freiburg, Germany
| | - Jürgen Finke
- Department of Hematology, Oncology and Stem Cell Transplantation, Albert-Ludwigs University Medical Center, Freiburg, Germany.
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17
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Grubic Z, Burek Kamenaric M, Maskalan M, Stingl Jankovic K, Zunec R. Nonfrequent but well-documented, rare and very rare HLA alleles observed in the Croatian population. ACTA ACUST UNITED AC 2015; 84:560-4. [PMID: 25413106 DOI: 10.1111/tan.12476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 08/25/2014] [Accepted: 10/15/2014] [Indexed: 12/27/2022]
Abstract
The aim of the study was to evaluate the presence of nonfrequent, rare and very rare alleles among Croats and to estimate whether they are associated with specific alleles at other human leukocyte antigen (HLA) loci. This retrospective study included the typing results from the last 10 years; total number of individuals included was approximately 45,000. Among 17 alleles so far observed only once in our population, 6 (A*24:41, B*07:02:28, B*35:03:03, B*39:40N, DRB1*13:23 and DRB1*14:111) belong to very rare alleles, 2 (B*44:16 and DRB1*01:31) belong to rare alleles according to the 'Rare Alleles Detector' tool ( www.allelefrequencies.net), while for the B*35:101:01 allele published data exist only in the IMGT/HLA database. The remaining eight HLA alleles observed only once among Croats are considered as frequent according to the 'Rare Alleles Detector'. Those 17 HLA alleles are not declared as common well defined (CWD) alleles in the CWD allele catalogue 2.0.0. Haplotype analysis of nonfrequent alleles detected in our sample supports the idea that different populations, although similar in some aspects regarding HLA allele and haplotype distribution, still have some unique characteristics. This is the case for A*01:02, B*39:10 and DRB1*13:32 which form haplotypes unreported to date among our subjects.
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Affiliation(s)
- Z Grubic
- Tissue Typing Centre, Clinical Department for Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
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18
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High-resolution HLA matching in unrelated donor transplantation in Switzerland: differential impact of class I and class II mismatches may reflect selection of nonimmunogenic or weakly immunogenic DRB1/DQB1 disparities. Bone Marrow Transplant 2015; 50:1201-5. [PMID: 26052916 DOI: 10.1038/bmt.2015.129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/24/2015] [Accepted: 04/28/2015] [Indexed: 12/15/2022]
Abstract
Unrelated donor searches in Switzerland require high-resolution HLA typing for HLA-A/B/C/DRB1/DRB3,4/DQB1 loci. We evaluated this strategy accepting donors with ⩾9/10 match. Of 802 unrelated donor transplants in 2000-2013, 570 were 10/10 matched, 31 were DRB3/4 mismatched, 261 were single-allele mismatched and 13 had 2 allele mismatches. Of the 261 single-allele disparities, 60 concerned HLA-A/-B, 55 HLA-C and 73 HLA-DRB1/-DQB1 loci. Transplants were reduced intensity conditioning (289, 36%), marrow (187, 23%), EBMT risk score was low in 39, intermediate I in 331, intermediate II in 333 and high in 99 patients. Five-year survival was 48±4%. HLA affected survival in the multivariate model adjusted for risk score. HLA-A/-B and HLA-C mismatches had twice the mortality risks, whereas HLA-DRB1/-DQB1 mismatches were similar to matched transplants. HLA-DRB3/4 mismatches were associated with a nonsignificant increased mortality risk. HLA-DRB3/4 mismatches had higher graft-versus-host disease and transplant-related mortality risks and lower relapse rates compared with matched transplants. We show significant effects of HLA class I, but not HLA class II, mismatches. The lack of impact of DRB1 disparities may be related to the lower immunogenicity of the DRB1*11:01/11:04 and DRB1*14:01/14:54 mismatches, representing 46% of DRB1 incompatibilities. These results support a matching algorithm that prioritizes mismatches considered as more permissive.
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19
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Tiwari AK, Bhati-Kushwaha H, Kukreja P, Mishra VC, Tyagi N, Sharma A, Raina V. Probability of Finding Marrow Unrelated Donor (MUD) for an Indian patient in a Multi-national Human Leukocyte Antigen (HLA) Registry. Indian J Hematol Blood Transfus 2015; 31:186-95. [PMID: 25825557 PMCID: PMC4375143 DOI: 10.1007/s12288-014-0416-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 05/29/2014] [Indexed: 01/17/2023] Open
Abstract
With an increase in the number of transplants happening globally, hematopoietic stem cells (HSC) transplantation from matched unrelated donor (MUD) has begun. The increasing trend of MUD transplants across countries has been largely facilitated with the conspicuous growth of volunteer HSC donor noted in the last decade i.e. 8 million HSC donors in 2002 to more than 22 million in 2013 registered in 71 member registries of the Bone Marrow Donor Worldwide (BMDW). Some populations of the world are still very poorly represented in these registries. Since, the chances of successful engraftment and disease free survival are directly proportional to the HLA compatibility between the recipient and the prospective donor, the diversity of the HLA system at the antigenic and allelic level and the heterogeneity of HLA data of the registered donors has a bearing on the probability of finding a volunteer unrelated HSC donor for patients from such populations. In the present study 126 patients were identified suffering from hematological diseases requiring MUD transplant. Their HLA typing was performed and search was done using BMDW database. The search results for these Indian patients in the multinational registry as well as in the Indian Registries were analyzed using mean, range, standard deviation and finally evaluated in terms of probability for finding matched donor (MUD). Total Asian population is only 11 % in the BMDW making it difficult to find a MUD for an Asian patient. The current study supports this, experimentally; revealing that the probability of finding an allele match for an Indian patient in the multinational Human Leukocyte Antigen (HLA) registries is 16 % and a dismal 0.008 % in the Indian registries (donors in Indian registries is just 33,678 as compared to 22.5 million in BMDW). This greatly, emphasizes on enhancing the number of Indian donors in Indian and multi-national registries.
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Affiliation(s)
- Aseem K. Tiwari
- />Transfusion Medicine, Medanta- The Medicity, Gurgaon, India
| | - Himakshi Bhati-Kushwaha
- />Nanobiotechnology, Bharat Stem Cell, c/o Safe Blood Organization, 209-C, II and III Floor, South Extension, Masjid Moth, New Delhi, 110049 India
| | - Pooja Kukreja
- />Applied Microbiology and Biotechnology, Bharat Stem Cell, New Delhi, India
| | | | - Neetu Tyagi
- />Biotechnology, Molecular Biology Laboratory, Medanta-The Medicity, Gurgaon, India
| | - Ashish Sharma
- />Medical Laboratory Technology, Bharat Stem Cell, New Delhi, India
| | - Vimarsh Raina
- />Molecular Genetics & Transplant, Immunology Laboratory, Medanta-The Medicity, Gurgaon, India
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20
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Solomon SR, Sizemore CA, Sanacore M, Zhang X, Brown S, Holland HK, Morris LE, Bashey A. Total Body Irradiation-Based Myeloablative Haploidentical Stem Cell Transplantation Is a Safe and Effective Alternative to Unrelated Donor Transplantation in Patients Without Matched Sibling Donors. Biol Blood Marrow Transplant 2015; 21:1299-307. [PMID: 25797174 DOI: 10.1016/j.bbmt.2015.03.003] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/06/2015] [Indexed: 12/14/2022]
Abstract
We enrolled 30 patients on a prospective phase II trial utilizing a total body irradiation (TBI)-based myeloablative preparative regimen (fludarabine 30 mg/m2/day × 3 days and TBI 150 cGy twice per day on day -4 to -1 [total dose 1200 cGy]) followed by infusion of unmanipulated peripheral blood stem cells from a haploidentical family donor (haplo). Postgrafting immunosuppression consisted of cyclophosphamide 50 mg/kg/day on days 3 and 4, mycophenolate mofetil through day 35, and tacrolimus through day 180. Median patient age was 46.5 years (range, 24 to 60). Transplantation diagnosis included acute myelogenous leukemia (n = 16), acute lymphoblastic leukemia (n = 6), chronic myelogenous leukemia (n = 5), myelodysplastic syndrome (n = 1), and non-Hodgkin's lymphoma (n = 2). Using the Dana Farber/Center for International Blood and Marrow Transplant Research/Disease Risk Index (DRI), patients were classified as low (n = 4), intermediate (n = 12), high (n = 11), and very high (n = 3) risk. All patients engrafted with a median time to neutrophil and platelet recovery of 16 and 25 days, respectively. All evaluable patients achieved sustained complete donor T cell and myeloid chimerism by day +30. Acute graft-versus-host disease (GVHD) grades II to IV and III and IV was seen in 43% and 23%, respectively. The cumulative incidence of chronic GVHD was 56% (severe in 10%). After a median follow-up of 24 months, the estimated 2-year overall survival (OS), disease-free survival (DFS), nonrelapse mortality, and relapse rate were 78%, 73%, 3%, and 24%, respectively. Two-year DFS and relapse rate in patients with low/intermediate risk disease was 100% and 0%, respectively, compared with 39% and 53% for patients with high/very high risk disease. When compared with a contemporaneously treated cohort of patients at our institution receiving myeloablative HLA-matched unrelated donor (MUD) transplantation (acute myelogenous leukemia [n = 17], acute lymphoblastic leukemia [n = 15], chronic myelogenous leukemia [n = 7], myelodysplastic syndrome [n = 7], non-Hodgkin lymphoma [n = 1], chronic lymphoblastic leukemia [n = 1]), outcomes were statistically similar, with 2-yr OS and DFS being 78% and 73%, respectively after haplo transplantation versus 71% and 64%, respectively, after MUD transplantation. In patients with DRI low/intermediate risk disease, 2-yr DFS was superior after haplo compared with MUD transplantations (100% versus 74%, P = .032), whereas there was no difference in DFS in patients with high/very high risk disease (39% versus 37% for haplo and MUD respectively, P = .821). Grade II to IV acute GVHD was seen less often after haplo compared with MUD transplantation (43% versus 63%, P = .049), as was moderate-to-severe chronic GVHD (22% versus 58%, P = .003). Myeloablative haplo transplantation using this regimen is a valid option for patients with advanced hematologic malignancies who lack timely access to a conventional donor. Outcomes appear at least equivalent to those seen in contemporaneous patients who underwent transplantation from MUD.
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Affiliation(s)
- Scott R Solomon
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia.
| | - Connie A Sizemore
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
| | - Melissa Sanacore
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
| | - Xu Zhang
- Department of Mathematics and Statistics, Georgia State University, Atlanta, Georgia
| | - Stacey Brown
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
| | - H Kent Holland
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
| | - Lawrence E Morris
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
| | - Asad Bashey
- Blood and Marrow Transplant Program, Northside Hospital, Atlanta, Georgia
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21
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Eberhard HP, Müller CR. The Impact of HLA-C Matching on Donor Identification Rates in a European-Caucasian Population. Front Immunol 2014; 5:501. [PMID: 25360136 PMCID: PMC4197773 DOI: 10.3389/fimmu.2014.00501] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/27/2014] [Indexed: 11/13/2022] Open
Abstract
The degree of HLA concordance with the patient has long been known to be the major donor-related prediction factor for the success of hematopoietic stem cell transplantations and, with the progress of HLA typing technology, selection criteria became more stringent with regard to the recommended loci and resolution. A late refinement was HLA-C matching, which gained broader acceptance only after the turn of the millennium. The enormous HLA polymorphism has always necessitated registries with a large number of donors in order to be able to provide well-matched donors to a substantial fraction of patients. Using a biostatistical approach, we investigated the impact of adding HLA-C at low or high resolution as a supplementary matching criterion on some key parameters in donor provision for a European-Caucasian population. Starting point is donor selection based on allele level matching for HLA-A, -B, -DRB1, and, optionally, HLA-DQB1. Without typing for HLA-C, 68% of the donors selected based on matching for HLA-A, -B, -DRB1, and -DQB1 at high resolution will also match for HLA-C, 29% will have a single and only 3% will have two HLA-C alleles different from the patient. In order to provide the same fraction of patients with a fully matched donor, a registry would have to be about twice the size if HLA-C is considered in addition to the four other loci, with the exact factor increasing with the registry's size. If the provision of donors with up to a single allele mismatch is considered, this factor doubles due to the strong linkage between HLA-B and -C. These figures only change slightly when HLA-DQB1 is completely ignored or HLA-C matching is only considered at low resolution. Our results contribute to quantifying the medical and economic impact of the progress in donor selection algorithms.
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Affiliation(s)
| | - Carlheinz R Müller
- Zentrales Knochenmarkspender-Register Deutschland (ZKRD) , Ulm , Germany
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22
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Vidan-Jeras B, Buhler S, Dubois V, Grubic Z, Ivanova M, Jaatinen T, Ligeiro D, Lokki ML, Papasteriades C, Poli F, Spyropoulou-Vlachou M, Tordai A, Viken M, Wenda S, Nunes J, Sanchez-Mazas A, Tiercy JM. Resolution ofHLA-B*44:02:01G, -DRB1*14:01:01Gand -DQB1*03:01:01Greveals a high allelic variability among 12 European populations. ACTA ACUST UNITED AC 2014; 84:459-64. [DOI: 10.1111/tan.12422] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 11/29/2022]
Affiliation(s)
- B. Vidan-Jeras
- Tissue Typing Center; Blood Transfusion Center of Slovenia; Ljubljana Slovenia
| | - S. Buhler
- Laboratory of Anthropology, Genetics and Peopling History, Department of Genetics and Evolution - Anthropology Unit and Institute of Genetics and Genomics in Geneva (IGE3); University of Geneva; Geneva Switzerland
| | - V. Dubois
- Etablissement Français du Sang (EFS) Rhône-Alpes; Laboratoire HLA; Lyon France
| | - Z. Grubic
- Tissue Typing Centre; University Hospital Centre Zagreb; Zagreb Croatia
| | - M. Ivanova
- Department of Clinical Immunology; University Hospital Alexandrovska; Sofia Bulgaria
| | - T. Jaatinen
- Finnish Red Cross Blood Service; Clinical Laboratory; Helsinki Finland
| | - D. Ligeiro
- Centro de Histocompatibilidad do Sul; Instituto Português de Sangue e Transplantaçâo; Lisbon Portugal
| | - M.-L. Lokki
- Transplantation Laboratory, Haartman Institute; University of Helsinki; Helsinki Finland
| | - C. Papasteriades
- Department of Immunology and Histocompatibility; Evangelismos Hospital; Athens Greece
| | - F. Poli
- Organ and Tissue Transplantation Immunology, Regenerative Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - M. Spyropoulou-Vlachou
- Immunology Department - Tissue Typing Laboratory; General University Hospital of Athens Alexandra; Athens Greece
| | - A. Tordai
- Hungarian National Blood Transfusion Center; Transplantation Immunogenetics Laboratory; Budapest Hungary
| | - M.K. Viken
- Department of Immunology; Oslo University Hospital and University of Oslo; Oslo Norway
| | - S. Wenda
- Department for Blood Group Serology; Medical University Vienna; Wien Austria
| | - J.M. Nunes
- Laboratory of Anthropology, Genetics and Peopling History, Department of Genetics and Evolution - Anthropology Unit and Institute of Genetics and Genomics in Geneva (IGE3); University of Geneva; Geneva Switzerland
| | - A. Sanchez-Mazas
- Laboratory of Anthropology, Genetics and Peopling History, Department of Genetics and Evolution - Anthropology Unit and Institute of Genetics and Genomics in Geneva (IGE3); University of Geneva; Geneva Switzerland
| | - J.-M. Tiercy
- National Reference Laboratory for Histocompatibility; University Hospital Geneva; Geneva Switzerland
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23
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Tiercy JM. HLA-C Incompatibilities in Allogeneic Unrelated Hematopoietic Stem Cell Transplantation. Front Immunol 2014; 5:216. [PMID: 24904572 PMCID: PMC4032933 DOI: 10.3389/fimmu.2014.00216] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 04/29/2014] [Indexed: 11/14/2022] Open
Abstract
An increasingly larger fraction of patients with hematological diseases are treated by hematopoietic stem cells transplantation (HSCT) from HLA matched unrelated donors. Polymorphisms of HLA genes represent a major barrier to HSCT because HLA-A, -B, -C and DRB1 incompatibilities confer a higher risk of acute graft-versus-host disease (aGVHD) and mortality. Although >22 million volunteer HLA-typed donors are available worldwide, still a significant number of patients do not find a highly matched HSC donor. Because of the large haplotypic diversity in HLA-B–C associations, incompatibilities occur most frequently at HLA-C, so that unrelated donors with a single HLA-C mismatch often represent the only possible choice. The ratio of HLA-C-mismatched HSCT over the total number of transplants varies from 15 to 30%, as determined in 12 multicenter studies. Six multicenter studies involving >1800 patients have reported a 21–43% increase in mortality risk. By using in vitro cellular assays, a large heterogeneity in T-cell allorecognition has been observed. Yet the permissiveness of individual HLA-C mismatches remains poorly defined. It could be linked to the position and nature of the mismatched residues on HLA-C molecules, but also to variability in the expression levels of the mismatched alleles. The permissive C*03:03–03:04 mismatch is characterized by full compatibility at residues 9, 97, 99, 116, 152, 156, and 163 reported to be key positions influencing T-cell allorecognition. With a single difference among these seven key residues the C*07:01–07:02 mismatch might also be considered by analogy as permissive. High variability of HLA-C expression as determined by quantitative RT-PCR has been observed within individual allotypes and shows some correlation with A–B–C–DRB1 haplotypes. Thus in addition to the position of mismatched amino acid residues, expression level of patient’s mismatched HLA-C allotype might influence T-cell allorecognition, with patients low expression-C alleles representing possible permissive mismatches.
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Affiliation(s)
- Jean-Marie Tiercy
- Transplantation Immunology Unit, National Reference Laboratory for Histocompatibility, Department of Genetics and Laboratory Medicine, University Hospital of Geneva, University of Geneva , Geneva , Switzerland
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24
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Testi M, Andreani M, Locatelli F, Arcese W, Troiano M, Battarra M, Gaziev J, Lucarelli G. Influence of the HLA characteristics of Italian patients on donor search outcome in unrelated hematopoietic stem cell transplantation. ACTA ACUST UNITED AC 2014; 84:198-205. [DOI: 10.1111/tan.12355] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/11/2014] [Accepted: 03/19/2014] [Indexed: 11/28/2022]
Affiliation(s)
- M. Testi
- Laboratory of Immunogenetics and Transplant Biology; IME Foundation at Polyclinic of Tor Vergata; Rome Italy
| | - M. Andreani
- Laboratory of Immunogenetics and Transplant Biology; IME Foundation at Polyclinic of Tor Vergata; Rome Italy
| | - F. Locatelli
- Department of Pediatric Hematology-Oncology, IRCCS Bambino Gesù Children's Hospital; University of Pavia; Rome Italy
| | - W. Arcese
- Rome Transplant Network, Department of Hematology, Stem Cell Transplant Unit; Tor Vergata University; Rome Italy
| | - M. Troiano
- Laboratory of Immunogenetics and Transplant Biology; IME Foundation at Polyclinic of Tor Vergata; Rome Italy
| | - M. Battarra
- Laboratory of Immunogenetics and Transplant Biology; IME Foundation at Polyclinic of Tor Vergata; Rome Italy
| | - J. Gaziev
- Rome Transplant Network, Department of Hematology, Stem Cell Transplant Unit; Tor Vergata University; Rome Italy
| | - G. Lucarelli
- International Center for Transplantation in Thalassemia and Sickle Cell Anemia; IME Foundation at Polyclinic of Tor Vergata; Rome Italy
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Traeger-Synodinos J, Kakourou G, Destouni A, Kanavakis E. Eleven years of preimplantation genetic diagnosis for human leukocyte antigen matching: is there room for improvement? Expert Rev Hematol 2014; 6:215-7. [DOI: 10.1586/ehm.13.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Garcia MC, Chapman JR, Shaw PJ, Gottlieb DJ, Ralph A, Craig JC, Tong A. Motivations, Experiences, and Perspectives of Bone Marrow and Peripheral Blood Stem Cell Donors: Thematic Synthesis of Qualitative Studies. Biol Blood Marrow Transplant 2013; 19:1046-58. [DOI: 10.1016/j.bbmt.2013.04.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 04/12/2013] [Indexed: 11/16/2022]
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27
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Bettens F, Schanz U, Tiercy JM. Lack of recognition of HLA class I mismatches outside α1/α2 domains by CD8+ alloreactive T lymphocytes: the HLA-B44 paradigm. ACTA ACUST UNITED AC 2013; 81:414-8. [DOI: 10.1111/tan.12102] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 02/12/2013] [Accepted: 02/19/2013] [Indexed: 11/27/2022]
Affiliation(s)
- F. Bettens
- National Reference Laboratory for Histocompatibility, Transplantation Immunology Unit, Department of Genetics and Laboratory Medicine; University Hospital Geneva; Geneva; Switzerland
| | - U. Schanz
- Division of Hematology; University Hospital Zürich; Zürich; Switzerland
| | - J.-M. Tiercy
- National Reference Laboratory for Histocompatibility, Transplantation Immunology Unit, Department of Genetics and Laboratory Medicine; University Hospital Geneva; Geneva; Switzerland
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