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Barriga F, Lima ACM. Donor selection in allogeneic stem cell transplantation. Curr Opin Hematol 2024; 31:261-269. [PMID: 39046889 DOI: 10.1097/moh.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
PURPOSE OF REVIEW Recent progress in human leukocyte antigen (HLA) characterization, increased accrual of unrelated donors and cord blood units, and a new platform for haploidentical transplantation have resulted in the widespread availability of donors for allogeneic hematopoietic stem cell transplantation. RECENT FINDINGS Advances in HLA typing have identified an increasing number of loci and alleles that are crucial for successful transplantation. Newer HLA A, B, C, DRB1, and DQB1 alleles, DPB1 mismatches, and HLA B leader sequence matching are incorporated into donor selection algorithms. Donor selection is highly relevant because of recently published conflicting studies using different donor types. These studies are largely retrospective and compare patients with different diseases and stages, conditioning regimens, graft versus host disease (GVHD) prophylaxis, and time periods. A broad consensus indicates that the best donor is an available matched sibling, followed by a matched unrelated donor, and then alternative donors such as haploidentical, mismatched unrelated, and cord blood units. This consensus is being challenged by other factors, such as donor age, patient condition, urgency of transplantation, and costs involved. SUMMARY In this review, we will analyze the unique characteristics of each donor type, the HLA and non HLA factors that affect donor choices, and the outstanding comparative outcome studies of different donor usage in hematologic malignancies.
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Affiliation(s)
- Francisco Barriga
- Section of Hematology, Oncology and Stem Cell Transplantation, Pontificia Universidad Católica de Chile, Stem Cell Collection Center, Fundación de Beneficiencia Pública DKMS, Santiago, Chile
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2
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Arrieta-Bolaños E. From clones to immunopeptidomes: New developments in the characterization of permissive HLA-DP mismatches in hematopoietic cell transplantation. Best Pract Res Clin Haematol 2024; 37:101575. [PMID: 39396259 DOI: 10.1016/j.beha.2024.101575] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/02/2024] [Accepted: 08/26/2024] [Indexed: 10/15/2024]
Abstract
Mismatching at the HLA-DPB1 locus occurs frequently in hematopoietic cell transplantation with unrelated donors. Despite this, HLA-DPB1 allelic mismatches have traditionally not been considered in patient-donor matching. A T-cell epitope (TCE) model for the functional assessment of permissive mismatches at this locus has nevertheless been adopted in clinical practice. While initially based on a hierarchical immunogenicity elucidated from allorecognition by T-cell clones isolated from a patient, newer developments in the understanding of this model's biological basis, including a central role for immunopeptidome divergence between mismatched allotypes, have prompted changes in the assignment of permissiveness, providing the opportunity for a more granular evaluation of graft-versus-host disease and relapse risks according to the nature and directionality of permissive mismatches. How these advances impact the assessment of permissiveness at HLA-DPB1 and potentially the intelligent selection of donors according to the main clinical goal for different patients is the subject of the present review.
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3
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Crocchiolo R, Fusco C, Andreani M, Rombolà G, Falco M, Vecchiato C, Garbarino L, Mele L, Mazzi AB, Picardi A, Lombardini L, Pollichieni S, De Stefano MC, Ciceri F, Cardillo M, Papola F. Histocompatibility assessment in hematopoietic stem cell transplantation: recommendations from the Italian Society for Immunogenetics and Transplantation Biology (Associazione Italiana di Immunogenetica e Biologia dei Trapianti - AIBT). BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2024; 22:338-349. [PMID: 37458719 PMCID: PMC11251828 DOI: 10.2450/bloodtransfus.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/30/2023] [Indexed: 07/18/2024]
Abstract
The outcome of allogeneic hematopoietic stem cell transplantation (HSCT) is significantly influenced by the degree of HLA histocompatibility between donor and recipient. To provide shared indications for required histocompatibility testing and interpretation before HSCT, the Italian Society for Immunogenetics and Transplantation Biology (Associazione Italiana di Immunogenetica e Biologia dei Trapianti [AIBT]) gathered members and created a working group to discuss and develop recommendations for histocompatibility assessment in HSCT.After a review of the literature and multiple panel discussions, AIBT developed up-to-date recommendations for the resolution levels of HLA typing, histocompatibility definitions of patients and donors, importance of anti-HLA antibodies, and significance of NK alloreactivity, which are reported in this document. These recommendations have been shared with the Italian Group for Bone Marrow Transplantation (Gruppo Italiano per il Trapianto di Midollo Osseo, cellule staminali emopoietiche e terapia cellulare [GITMO]) and the Italian National Center for Transplantation (Centro Nazionale Trapianti [CNT]). Notably, the increased use of HLA-mismatched transplantation (i.e., mismatched unrelated, haploidentical) in recent years has made these indications even more relevant for the standardization and improvement of quality of care.This document represents a useful instrument for health care workers involved in the field of HSCT, enhancing synergy with transplant physicians and enabling greater optimization of the available resources.
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Affiliation(s)
- Roberto Crocchiolo
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Caterina Fusco
- Cryopreservation and Ba.S.C.O Unit, Oncohaematology Department Santobono-Pausilipon Hospital Naples, Italy
| | - Marco Andreani
- Laboratory of Transplant Immunogenetics, Department of Hematology/Oncology, Cell and Gene Therapy, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | | | - Michela Falco
- Laboratory of Clinical and Experimental Immunology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Cinzia Vecchiato
- Servizio Aziendale di Immunoematologia e Trasfusionale, Azienda Sanitaria dell’Alto Adige, Bolzano, Italy
| | - Lucia Garbarino
- S.C. Laboratorio di Istocompatibilità, E O. Ospedali Galliera, Genoa, Italy
| | - Lia Mele
- Laboratorio HLA e processazione cellule staminali ematopoietiche, Azienda Ospedaliera SS Antonio e Biagio e C Arrigo, Alessandria, Italy
| | - Allegra B. Mazzi
- Immunogenetics Laboratory, HLA and Chimerism Dept. of Immunohematology and Blood Transfusion IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandra Picardi
- UOSC Ematologia con Trapianto CSE, AORN A. Cardarelli, Naples, Italy
- Gruppo Italiano per il Trapianto di Midollo Osseo, Cellule Staminali Emopoietiche e Terapia Cellulare, Bologna, Italy
| | - Letizia Lombardini
- Italian National Transplant Center, National Institute of Health, Rome, Italy
| | - Simona Pollichieni
- Gruppo Italiano per il Trapianto di Midollo Osseo, Cellule Staminali Emopoietiche e Terapia Cellulare, Bologna, Italy
| | - Maria C. De Stefano
- Italian National Transplant Center, National Institute of Health, Rome, Italy
| | - Fabio Ciceri
- Gruppo Italiano per il Trapianto di Midollo Osseo, Cellule Staminali Emopoietiche e Terapia Cellulare, Bologna, Italy
- Università Vita-Salute San Raffaele, U.O. Ematologia e Trapianto di Midollo, U.O. Medicina ad indirizzo Onco-Ematologico, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Cardillo
- Italian National Transplant Center, National Institute of Health, Rome, Italy
| | - Franco Papola
- Centro Regionale Immunoematologia e Tipizzazione Tissutale Ospedale S. Salvatore, ASL1 Avezzano Sulmona, L’Aquila, Italy
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4
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Yin Y, Soe NN, Valenzuela NM, Reed EF, Zhang Q. HLA-DPB1 genotype variants predict DP molecule cell surface expression and DP donor specific antibody binding capacity. Front Immunol 2024; 14:1328533. [PMID: 38274830 PMCID: PMC10808447 DOI: 10.3389/fimmu.2023.1328533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
The contribution of alloresponses to mismatched HLA-DP in solid organ transplantation and hematopoietic stem cell transplantation (HCT) has been well documented. Exploring the regulatory mechanisms of DPB1 alleles has become an important question to be answered. In this study, our initial investigation focused on examining the correlation between the rs9277534G/A SNP and DPB1 mRNA expression. The result showed that there was a significant increase in DPB1 mRNA expression in B lymphoblastoid cell lines (BLCLs) with the rs9277534GG genotype compared to rs9277534AA genotype. In addition, B cells with the rs9277534GG exhibited significantly higher DP protein expression than those carrying the rs9277534AA genotype in primary B cells. Furthermore, we observed a significant upregulation of DP expression in B cells following treatment with Interleukin 13 (IL-13) compared to untreated B cells carrying rs9277534GG-linked DPB1 alleles. Fluorescence in situ hybridization (FISH) analysis of DPB1 in BLCL demonstrated significant differences in both the cytoplasmic (p=0.0003) and nuclear (p=0.0001) localization of DP mRNA expression comparing DPB1*04:01 (rs9277534AA) and DPB1*05:01 (rs9277534GG) homozygous cells. The study of the correlation between differential DPB1 expression and long non-coding RNAs (lncRNAs) showed that lnc-HLA-DPB1-13:1 is strongly associated with DP expression (r=0.85), suggesting the potential involvement of lncRNA in regulating DP expression. The correlation of DP donor specific antibody (DSA) with B cell flow crossmatch (B-FCXM) results showed a better linear correlation of DP DSA against GG and AG donor cells (R2 = 0.4243, p=0.0025 and R2 = 0.6172, p=0.0003, respectively), compared to DSA against AA donor cells (R2 = 0.0649, p=0.4244). This explained why strong DP DSA with a low expression DP leads to negative B-FCXM. In conclusion, this study provides evidence supporting the involvement of lncRNA in modulating HLA-DP expression, shedding lights on the intricate regulatory mechanisms of DP, particularly under inflammatory conditions in transplantation.
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Affiliation(s)
- Yuxin Yin
- UCLA Immunogenetics Center, Department of Pathology & Laboratory Medicine, Los Angeles, CA, United States
| | - Nwe Nwe Soe
- Department of Pathology, AdventHealth Tissue Typing Laboratory, Orlando, FL, United States
| | - Nicole M. Valenzuela
- UCLA Immunogenetics Center, Department of Pathology & Laboratory Medicine, Los Angeles, CA, United States
| | - Elaine F. Reed
- UCLA Immunogenetics Center, Department of Pathology & Laboratory Medicine, Los Angeles, CA, United States
| | - Qiuheng Zhang
- UCLA Immunogenetics Center, Department of Pathology & Laboratory Medicine, Los Angeles, CA, United States
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5
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Sajulga R, Bolon YT, Maiers MJ, Petersdorf EW. Assessment of HLA-DPB1 genetic variation using an HLA-DP tool and its implications in clinical transplantation. Blood Adv 2023; 7:4809-4821. [PMID: 37126658 PMCID: PMC10469530 DOI: 10.1182/bloodadvances.2022009554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/06/2023] [Accepted: 04/23/2023] [Indexed: 05/03/2023] Open
Abstract
HLA-DP is a classic transplantation antigen that mediates alloreactivity through T-cell epitope (TCE) diversity and expression levels. A current challenge is to integrate these functional features into the prospective selection of unrelated donor candidates for transplantation. Genetically, HLA-DPB1 exon 2 defines the permissive and nonpermissive TCE groups, and exons 2 and 3 (in linkage with rs9277534) indicate low- and high-expression allotypes. In this study, we analyzed 356 272 exon 2-exon 3-phased sequences from individuals across 5 self-identified race and ethnicity categories: White, Hispanic, Asian or Pacific Islander, Black or African American, and American Indian or Alaskan Native. This sequence data set revealed the complex relationship between TCE and expression models and the importance of exon 3 sequence data. We also studied archived donor search lists for 2545 patients who underwent transplantation from an HLA-11/12 unrelated donor mismatched for a single HLA-DPB1 allele. Depending on the order in which the TCE and expression criteria were considered, some patients had different TCE- and expression-favorable donors. In addition, this data set revealed that many expression-favorable alternatives existed in the search lists. To improve the selection of candidate donors, we provide, disseminate, and automate our findings through our multifaceted tool called Expression of HLA-DP Assessment Tool, consisting of a public web application, Python package, and analysis pipeline.
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Affiliation(s)
- Ray Sajulga
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Yung-Tsi Bolon
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Martin J. Maiers
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Effie W. Petersdorf
- Division of Clinical Research, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
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6
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Arrieta-Bolaños E, Crivello P, He M, Wang T, Gadalla SM, Paczesny S, Marsh SGE, Lee SJ, Spellman SR, Bolon YT, Fleischhauer K. A core group of structurally similar HLA-DPB1 alleles drives permissiveness after hematopoietic cell transplantation. Blood 2022; 140:659-663. [PMID: 35609150 PMCID: PMC9373015 DOI: 10.1182/blood.2022015708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/12/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Esteban Arrieta-Bolaños
- Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, Essen, Germany
| | - Pietro Crivello
- Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany
| | - Meilun He
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Tao Wang
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
- CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Shahinaz M Gadalla
- Division of Cancer Epidemiology & Genetics, National Institutes of Health-National Cancer Institute Clinical Genetics Branch, Rockville, MD
| | - Sophie Paczesny
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC
| | - Steven G E Marsh
- Anthony Nolan Research Institute, London, United Kingdom
- UCL Cancer Institute, Royal Free Campus, London, United Kingdom
| | - Stephanie J Lee
- CIBMTR (Center for International Blood and Marrow Transplant Research), Medical College of Wisconsin, Milwaukee, WI; and
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Stephen R Spellman
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Yung-Tsi Bolon
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, MN
| | - Katharina Fleischhauer
- Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, Essen, Germany
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7
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Ruggeri A, de Wreede LC, Müller CR, Crivello P, Bonneville EF, Petersdorf EW, Socié G, Dubois V, Niittyvuopio R, Peräsaari J, Yakoub-Agha I, Cornelissen JJ, Wieten L, Gedde-Dahl T, Forcade E, Crawley CR, Marsh SG, Gandemer V, Tholouli E, Bulabois CE, Huynh A, Choi G, Deconinck E, Itäla-Remes M, Lenhoff S, Bengtsson M, Johansson JE, van Gorkom G, Hoogenboom JD, Vago L, Rocha V, Bonini C, Chabannon C, Fleischhauer K. Integrating biological HLA-DPB1 mismatch models to predict survival after unrelated hematopoietic cell transplantation. Haematologica 2022; 108:645-652. [PMID: 35546480 PMCID: PMC9890035 DOI: 10.3324/haematol.2021.280055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Indexed: 02/03/2023] Open
Affiliation(s)
- Annalisa Ruggeri
- San Raffaele Scientific Institute, Hematology and Bone Marrow Transplantation Unit, Milan, Italy,Cellular Therapy and Immunobiology Working Party of the EBMT, Leiden, the Netherlands
| | | | | | - Pietro Crivello
- Institute for Experimental Cellular Therapy, University Hospital Essen, Essen, Germany
| | | | | | | | | | | | - Juha Peräsaari
- Clinical Laboratory Services, Histocompatibility Testing, Finnish Red Cross Blood Service, Helsinki, Finland
| | | | | | - Lotte Wieten
- Transplantation Immunology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | | | | | - Steven G.E. Marsh
- Anthony Nolan Research Institute and UCL Cancer Institute, Royal Free Campus, London, UK
| | | | | | | | - Anne Huynh
- CHU - Institut Universitaire du Cancer Toulouse, Toulouse, France
| | - Goda Choi
- University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | | | | | | | - Mats Bengtsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | | | | | - Luca Vago
- San Raffaele Scientific Institute, Hematology and Bone Marrow Transplantation Unit, Milan, Italy,Cellular Therapy and Immunobiology Working Party of the EBMT, Leiden, the Netherlands
| | - Vanderson Rocha
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31) of the Service of Hematology and Cell Therapy, Hospital das Clínicas da Faculdade de Medicina da USP, São Paulo, SP, Brazil
| | - Chiara Bonini
- San Raffaele Scientific Institute, Hematology and Bone Marrow Transplantation Unit, Milan, Italy,Cellular Therapy and Immunobiology Working Party of the EBMT, Leiden, the Netherlands
| | - Christian Chabannon
- Cellular Therapy and Immunobiology Working Party of the EBMT, Leiden, the Netherlands,Institut PaoliCalmettes, Centre de Lutte Contre le Cancer, Centre d'Investigations Cliniques en Biothérapie, Université d'Aix-Marseille, Inserm CBT 1409, Marseille, France
| | - Katharina Fleischhauer
- Cellular Therapy and Immunobiology Working Party of the EBMT, Leiden, The Netherlands; Institute for Experimental Cellular Therapy, University Hospital Essen, Essen.
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8
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Analysis of biological models to predict clinical outcomes based on HLA-DPB1 disparities in unrelated transplantation. Blood Adv 2021; 5:3377-3386. [PMID: 34448833 DOI: 10.1182/bloodadvances.2020003998] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/23/2021] [Indexed: 11/20/2022] Open
Abstract
HLA compatibility is a key factor for survival after unrelated hematopoietic stem cell transplantation (HSCT). HLA-A, -B, -C, -DRB1, and -DQB1 are usually matched between donor and recipient. By contrast, HLA-DPB1 mismatches are frequent, although it is feasible to optimize donor selection and DPB1 matching with prospective typing. Because classical DPB1 allele mismatches are often unavoidable, however, several biological models have been developed to predict the optimal DPB1 mismatch combination for less graft-versus-host disease (GVHD) and better overall survival. In 909 recipient/donor pairs, we analyzed the role of 3 biological models: T-cell epitopes (TCEs) based on the immunogenicity of DPB1, cell surface expression of DPB1 molecules based on a single-nucleotide polymorphism located in the 3' untranslated region, and the Predicted Indirectly ReCognizable HLA Epitopes (PIRCHE) model based on the presentation of allogeneic peptides derived from mismatched HLA, compared with the classical allele mismatch. Matching for both DPB1 alleles remains the best option to prevent acute GVHD. In the situation of one DPB1 allele mismatch, the donor associated with the lowest acute GVHD risks is mismatched for an allele with a low expression profile in the recipient, followed by a permissive TCE3/4 mismatch and/or the absence of PIRCHE II potential against the recipient. In the context of 2 DPB1 mismatches, the same considerations apply for a permissive TCE3/4 mismatch and no PIRCHE II. By combining the biological models, the most favorable DPB1 constellation can be defined. This approach will help optimize donor selection and improve post-HSCT complications and patient prognosis.
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Hunziker M, Passweg J, Medinger M. Influence of HLA-DPB1 mismatches on outcome after allogeneic hematopoietic stem cell transplantation. Leuk Res Rep 2021; 16:100259. [PMID: 34345585 PMCID: PMC8319557 DOI: 10.1016/j.lrr.2021.100259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/04/2021] [Accepted: 07/11/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mireille Hunziker
- Division of Hematology, Department of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jakob Passweg
- Division of Hematology, Department of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Michael Medinger
- Division of Hematology, Department of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland.,Division of Internal Medicine, Department of Medicine, University Hospital Basel, and University of Basel, Basel, Switzerland
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10
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Crocchiolo R, Mele L, Testi M, Scollo Chiara M, Murgia B, Rossi A, Vecchiato C, Grammatico P, Mininni D, Longhi E, Manfroi S, Giuliodori S, Castellani L, Carella G, Lai S, Azzaro Maria P, Mazzi B, Perotti L, Penta R, Lombardo C, Tognellini R, Andreani M, Albergoni Maria P, Nesci S, Cappuzzo V, Chiusolo P, Garino E, Cappucci G, Ceschini N, Bevilacqua E, Guizzardi E, Tagliaferri Cinzia M, Piazza A, Carcassi C, Miotti V. Use of DPB1 T-cell epitope algorithm among italian transplant centers: A survey on behalf of Associazione Italiana di Immunogenetica e Biologia dei Trapianti. HLA 2021; 98:114-121. [PMID: 34155826 DOI: 10.1111/tan.14347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/01/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022]
Abstract
The HLA-DPB1 locus has been demonstrated to have a significant role on patients' outcome after allogeneic HSCT, and the so-called T-cell epitope (TCE) algorithm has been incorporated in international guidelines for the selection of unrelated donors. The purpose of the present study is to measure, through a national survey conducted on behalf of the Associazione Italiana di Immunogenetica e Biologia dei Trapianti (AIBT), the extent of awareness and use of HLA-DPB1 TCE-based algorithms during the donor search. 89% of the HLA laboratories answered to a short questionnaire and the results showed a progressive increase of the laboratories typing DPB1 in patients and their potential donors during the search (from 44% to 79% during the 2010-2019 period) as well as the application of a TCE-based algorithm for the donor choice whenever possible (from 24% to 65% during the same period). The DP-permissiveness status is detailed in the official HLA typing report by 12%, 32% and 50% of laboratories in 2010, 2015 and 2019, respectively. The present data indicate an encouraging raise in the awareness of the HLA-DPB1 role in unrelated donor selection; noteworthy, mentioning the TCE-based permissiveness status in the HLA typing report of each potential unrelated donor represents a notable mean to raise awareness among transplant physicians and to support them in their task of choosing the best donor. Nonetheless, despite the compelling evidence of the predictive ability of TCE-based algorithms, further efforts are still needed to extend its application to all transplant centers in Italy.
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Affiliation(s)
- Roberto Crocchiolo
- Servizio di Immunoematologia e Medicina Trasfusionale, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lia Mele
- Laboratorio HLA e processazione cellule staminali ematopoietiche, Azienda Ospedaliera SS Antonio e Biagio e C Arrigo, Alessandria, Italy; Treasurer, Associazione Italiana di Immunogenetica e Biologia dei Trapianti, AIBT, Alessandria, Italy
| | - Manuela Testi
- Secretary, Associazione Italiana di Immunogenetica e Biologia dei Trapianti, AIBT, Bologna, Italy
| | | | - Barbara Murgia
- SC laboratorio di istocompatibilità, EO Ospedali Galliera, Genoa, Italy
| | - Angela Rossi
- UOSD Immunogenetica e Manipolazione cellule staminali emopoietiche, Ospedale ''Guglielmo da Saliceto'', Piacenza, Italy
| | - Cinzia Vecchiato
- Transfusion Service, San Maurizio Regional Hospital, Bolzano, Italy
| | - Paola Grammatico
- UOC Laboratorio di Genetica Medica, Ospedale San Camillo, Rome, Italy
| | - Donata Mininni
- Tissue Typing and Immunology of Transplants Unit, Department of Diagnostic Pathology, University of Bari, Bari, Italy
| | - Elena Longhi
- Laboratory of Transplant Immunology, IRCCS Ca ' Granda Foundation Maggiore Policlinico Hospital Milan, Milan, Italy
| | - Silvia Manfroi
- Immunohaematology and Transfusion Medicine Service, S. Orsola-Malpighi Polyclinic, Bologna, Italy
| | | | - Laura Castellani
- UOC immunoematologia e medicina trasfusionale, Laboratorio immunogenetica - ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Graziella Carella
- Laboratorio di Istocompatibilità, ''Vittorio Mero'' Servizio di Immunoematologia e Medicina Trasfusionale, ASST Spedali Civili, Brescia, Italy
| | - Sara Lai
- SC Genetica Medica Cagliari - ATS Sardegna, Cagliari, Italy
| | - Pia Azzaro Maria
- Laboratorio di istocompatibilità, Centro Donatori di midollo Osseo (CD-CT02) dell'UOC di Ematologia con trapianto di Midollo Ossero - AOU Policlinico San Marco, Catania, Italy
| | - Benedetta Mazzi
- Immunogenetics laboratory, HLA & Chimerism - Dept. of ImmunoHematology & Blood Transfusion, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Laura Perotti
- Servizio di Immunoematologia e Trasfusionale, ASO Santa Croce e Carle, Cuneo, Italy
| | - Roberta Penta
- Laboratorio di istoconpatibilità, UOSD Criopreservazione e BaSCO, PO Pausilipon - AORN Santobono-Pausilipon, Naples, Italy
| | - Claudia Lombardo
- Laboratorio di Tipizzazione HLA, Servizio Di Immunoematologia e Medicina Trasfusionale, Fondazione IRCSS Istituto Tumori, Milan, Italy
| | - Rita Tognellini
- Laboratorio di immunogenetica e biologia dei trapianti, Servizio Immunoematologia e trasfusionale, Azienda Ospedaliera Perugia, Perugia, Italy
| | - Marco Andreani
- Transplantation Immunogenetics Laboratory, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Sonia Nesci
- Settore di Immunogenetica e Biologia dei Trapianti, S.S.D. Diagnostica ad alta complessità - Dipartimento di Diagnostica Clinica, Azienda Ospedali Riuniti Marche Nord-, Pesaro, Italy
| | - Valentina Cappuzzo
- Laboratorio Regionale di Tipizzazione Tessutale ed Immunologia dei Trapianti, U.O.C. Medicina Trasfusionale e dei Trapianti - P.O. Cervello - A.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy
| | - Elena Garino
- SC Immunogenetica e Biologia dei Trapianti, A.O.U. Città della Salute e della Scienza di Torino, Pavia, Italy
| | - Giuseppe Cappucci
- IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Nadia Ceschini
- Laboratorio di Tipizzazione Tissutale HLA, S.I.T., Ospedale Santa Chiara, Trento, Italy
| | - Elena Bevilacqua
- Laboratorio di Tipizzazione tissutale, Dipartimento di Medicina Trasfusionale, Azienda Sanitaria Universitaria Giuliano Isontina - ASUGI, Trieste, Italy
| | | | | | - Antonina Piazza
- Associazione Italiana di Immunogenetica e Biologia dei Trapianti, AIBT, Bologna, Italy
| | - Carlo Carcassi
- Medical Genetics, Department of Medical Sciences and Public Health, University of Cagliari, Associazione Italiana di Immunogenetica e Biologia dei Trapianti, AIBT, Cagliari, Italy
| | - Valeria Miotti
- Laboratory of Immunogenetics, Santa Maria della Misericordia University Hospital, Associazione Italiana di Immunogenetica e Biologia dei Trapianti, AIBT, Udine, Italy
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11
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Picardi A, Sacchi N, Miotti V, Lorentino F, Oldani E, Rambaldi A, Sessa M, Bruno B, Cerno M, Vago L, Bernasconi P, Arcese W, Benedetti F, Pioltelli P, Russo D, Farina L, Fagioli F, Guidi S, Saporiti G, Zallio F, Chiusolo P, Borghero C, Papalinetti G, La Rocca U, Milone G, Lamparelli T, Carella AM, Luppi M, Olivieri A, Martino M, Carluccio P, Celeghini I, Andreani M, Gallina AM, Patriarca F, Pollichieni S, Mammoliti S, Miccichè S, Mangione I, Ciceri F, Bonifazi F. Allelic HLA Matching and Pair Origin Are Favorable Prognostic Factors for Unrelated Hematopoietic Stem Cell Transplantation in Neoplastic Hematologic Diseases: An Italian Analysis by the Gruppo Italiano Trapianto di Cellule Staminali e Terapie Cellulari, Italian Bone Marrow Donor Registry, and Associazione Italiana di Immunogenetica e Biologia dei Trapianti. Transplant Cell Ther 2021; 27:406.e1-406.e11. [PMID: 33965179 DOI: 10.1016/j.jtct.2020.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/06/2020] [Accepted: 11/26/2020] [Indexed: 11/30/2022]
Abstract
HLA molecules are important for immunoreactivity in allogeneic hematopoietic stem cell transplantation (HSCT). The Gruppo Italiano Trapianto di Cellule Staminali e Terapie Cellulari, Italian Bone Marrow Donor Registry, and Associazione Italiana di Immunogenetica e Biologia dei Trapianti promoted a retrospective observational study to evaluate HLA matching and the impact of allelic HLA mismatching and non-HLA factors on unrelated Italian HSCT outcomes. From 2012 to 2015, 1788 patients were enrolled in the study. The average donor age was 29 years and the average recipient age was 49 years. As a conditioning regimen, 71% of the patients received myeloablative conditioning. For GVHD prophylaxis, 76% received either antithymocyte or anti-T lymphocyte globulin, cyclosporine A, and methotrexate. Peripheral blood was the stem cell source in 80%. The median duration of follow-up was 53 months. Regarding HLA matching, 50% of donor-recipient pairs were 10/10 matched, 38% had 1 mismatch, and 12% had 2 or more mismatches. A total of 302 pairs shared Italian origin. Four-year overall survival (OS), progression-free survival, GVHD-free relapse-free survival, and relapse rates were 49%, 40%, 22%, and 34%, respectively. The 4-year NRM was 27%, and the 100-day cumulative incidence of grade ≥II acute GVHD (aGVHD) was 26%. In multivariate analysis, 9/10 and ≤8/10 HLA allele-matched pairs were associated with worse OS (P = .04 and .007, respectively), NRM (P = .007 and P < .0001, respectively), and grade III-IV aGVHD (P = .0001 and .01, respectively). Moreover, the incidences of grade II-IV aGVHD (P = .001) and chronic GVHD (P = .002) were significantly lower in Italian pairs. In conclusion, 10/10 HLA matching is a favorable prognostic factor for unrelated HSCT outcome in the Italian population. Moreover, the presence of 2 HLA-mismatched loci was associated with a higher NRM (P < .0001) and grade II-IV aGVHD (P = .006) and a poorer OS (P = .001) compared with 1 HLA-mismatched locus in early or intermediate disease phases. Finally, we found that Italian donor and recipient origin is a favorable prognostic factor for GVHD occurrence.
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Affiliation(s)
- Alessandra Picardi
- Department of Biomedicine and Prevention, Tor Vergata University, Fondazione Policlinico Tor Vergata-Rome Transplant Network, Roma, Italy; Unit of Hematology and HSC Transplant Program, AORN Cardarelli, Napoli, Italy.
| | - Nicoletta Sacchi
- Italian Bone Marrow Donor Registry, Ospedale Galliera, Genova, Italy
| | - Valeria Miotti
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Associazione Italiana di Immunogenetica e Biologia dei Trapianti, Bologna, Italy
| | - Francesca Lorentino
- Program in Public Health, Department of Medicine and Surgery, University of Milano Bicocca, Milano, Italy
| | - Elena Oldani
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Alessandro Rambaldi
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; Department of Oncology and Hematology, University of Milan, Milano, Italy
| | - Mariarosaria Sessa
- Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale Sant'Anna, Ferrara, Italy
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, AOU Città della Salute e della Scienza, University of Torino, Torino, Italy; Department of Molecular Biotechnology and Health Sciences, University Hospital Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Michela Cerno
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Luca Vago
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milano, Italy
| | - Paolo Bernasconi
- SC Ematologia Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - William Arcese
- Department of Biomedicine and Prevention, Tor Vergata University, Fondazione Policlinico Tor Vergata-Rome Transplant Network, Roma, Italy
| | - Fabio Benedetti
- Department of Medicine, Section of Hematology and Bone Marrow Transplant Unit, University of Verona, Verona, Italy
| | - Pietro Pioltelli
- Ospedale San Gerardo, Clinica Ematologica dell'Università Milano-Bicocca, Monza, Italy
| | - Domenico Russo
- Bone Marrow Transplant Unit, ASST-Spedali Civili di Brescia, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lucia Farina
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Franca Fagioli
- Children's Hospital Regina Margherita, University of Turin, Torino, Italy; University of Turin, Torino, Italy
| | | | - Giorgia Saporiti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Francesco Zallio
- Hematology Department, SS Antonio & Biagio and C. Arrigo Hospital, Alessandria, Italy
| | - Patrizia Chiusolo
- Diagnostic imaging, oncological radiotherapy and hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
| | | | | | - Ursula La Rocca
- Hematology Department, University Hospital Policlinico Umberto I, Sapienza University, Roma, Italy
| | - Giuseppe Milone
- Department of Hematology and bone and marrow transplant unit-Azienda Ospedaliera Policlinico di Catania, Catania, Italy
| | | | - Angelo M Carella
- Bone Marrow Transplant Unit, Department of Medical Sciences, Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Mario Luppi
- Ematologia - Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Attilio Olivieri
- Clinica Di Ematologia Università Politecnica Delle Marche, Ancona, Italy
| | - Massimo Martino
- Stem Cell Transplant and Cellular Therapies Unit, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Paola Carluccio
- Hematology and Bone Marrow Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Marco Andreani
- Associazione Italiana di Immunogenetica e Biologia dei Trapianti, Bologna, Italy; Transplantation Immunogenetics Laboratory, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Anna M Gallina
- Italian Bone Marrow Donor Registry, Ospedale Galliera, Genova, Italy
| | - Francesca Patriarca
- Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Department of Medical Area, University of Udine, Udine, Italy
| | | | - Sonia Mammoliti
- Trials Office, GITMO Gruppo Italiano per il Trapianto di Midollo Osseo, Cellule Staminali Emopoietiche e Terapia Cellulare, Genova, Italy
| | - Silvia Miccichè
- Department of Biomedicine and Prevention, Tor Vergata University, Fondazione Policlinico Tor Vergata-Rome Transplant Network, Roma, Italy
| | - Ilaria Mangione
- Department of Biomedicine and Prevention, Tor Vergata University, Fondazione Policlinico Tor Vergata-Rome Transplant Network, Roma, Italy
| | - Fabio Ciceri
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milano, Italy
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12
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Holtan SG, Versluis J, Weisdorf DJ, Cornelissen JJ. Optimizing Donor Choice and GVHD Prophylaxis in Allogeneic Hematopoietic Cell Transplantation. J Clin Oncol 2021; 39:373-385. [PMID: 33434075 DOI: 10.1200/jco.20.01771] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Shernan G Holtan
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Jurjen Versluis
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - Daniel J Weisdorf
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Jan J Cornelissen
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
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13
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Petersdorf EW, Bengtsson M, De Santis D, Dubois V, Fleischhauer K, Gooley T, Horowitz M, Madrigal JA, Malkki M, McKallor C, Morishima Y, Oudshoorn M, Spellman SR, Villard J, Stevenson P, Carrington M. Role of HLA-DP Expression in Graft-Versus-Host Disease After Unrelated Donor Transplantation. J Clin Oncol 2020; 38:2712-2718. [PMID: 32479188 PMCID: PMC7430213 DOI: 10.1200/jco.20.00265] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The main aim of this study was to evaluate the significance of HLA-DPB1 expression in acute graft-versus-host disease (GVHD) after hematopoietic cell transplantation (HCT) from HLA-A, -B, -C, -DRB1, -DQB1-matched and -mismatched unrelated donors. PATIENTS AND METHODS Between January 1, 2017, and January 10, 2019, we assessed 19,136 patients who received HCT from an HLA-A, -B, -C, -DRB1, -DQB1-matched or -mismatched unrelated donor performed in Australia, the European Union, Japan, North America, and the United Kingdom between 1988 and 2016. Among transplant recipients with one HLA-DPB1 mismatch, the patient's mismatched HLA-DPB1 allotype was defined as low or high expression. Multivariable regression models were used to assess risks of GVHD associated with high expression relative to low expression HLA-DPB1 mismatches. The effect of increasing numbers of HLA-DPB1 mismatches on clinical outcome was assessed in HLA-mismatched transplant recipients. RESULTS In HLA-A, -B, -C, -DRB1,-DQB1-matched transplant recipients, donor mismatching against one high-expression patient HLA-DPB1 increased moderate (odds ratio [OR], 1.36; P = .001) and severe acute GVHD (OR, 1.32; P = .0016) relative to low-expression patient mismatches, regardless of the expression level of the donor's mismatched HLA-DPB1. Among transplant recipients with one HLA-A, -B, -C, -DRB1, or -DQB1 mismatch, the odds of acute GVHD increased with increasing numbers of HLA-DPB1 mismatches (OR, 1.23 for one; OR, 1.40 for two mismatches relative to zero mismatches for moderate GVHD; OR, 1.19 for one; OR, 1.40 for two mismatches relative to zero for severe GVHD), but not with the level of expression of the patient's mismatched HLA-DPB1 allotype. CONCLUSION The level of expression of patient HLA-DPB1 mismatches informs the risk of GVHD after HLA-A, -B, -C, -DRB1, -DQB1-matched unrelated HCT, and the total number of HLA-DPB1 mismatches informs the risk of GVHD after HLA-mismatched unrelated HCT. Prospective consideration of HLA-DPB1 may help to lower GVHD risks after transplantation.
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Affiliation(s)
- Effie W. Petersdorf
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Mats Bengtsson
- Department of Immunology, Genetics, and Pathology, University of Uppsala, Uppsala, Sweden
| | | | - Valerie Dubois
- Etablissement Français du Sang Auvergne Rhône Alpes, site de Lyon, Décines, France
| | - Katharina Fleischhauer
- Institute for Experimental Cellular Therapy, University of Duisburg-Essen, Essen, Germany
| | - Ted Gooley
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mary Horowitz
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Mari Malkki
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Caroline McKallor
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Yasuo Morishima
- Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Machteld Oudshoorn
- Leiden University Medical Centre, Department Immunohematology and Blood Transfusion, Leiden, the Netherlands
- Matchis Foundation, Leiden, the Netherlands
| | - Stephen R. Spellman
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
| | | | - Phil Stevenson
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mary Carrington
- Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, MD
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge, MA
| | - on behalf of the
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Department of Immunology, Genetics, and Pathology, University of Uppsala, Uppsala, Sweden
- PathWest, Fiona Stanley Hospital, Perth, WA, Australia
- Etablissement Français du Sang Auvergne Rhône Alpes, site de Lyon, Décines, France
- Institute for Experimental Cellular Therapy, University of Duisburg-Essen, Essen, Germany
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
- Anthony Nolan Research Institute, Royal Free Hospital, London, United Kingdom
- Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
- Leiden University Medical Centre, Department Immunohematology and Blood Transfusion, Leiden, the Netherlands
- Matchis Foundation, Leiden, the Netherlands
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
- Geneva University Hospital, Geneva, Switzerland
- Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, MD
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge, MA
| | - International Histocompatibility Working Group in Hematopoietic-Cell Transplantation
- Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
- Department of Immunology, Genetics, and Pathology, University of Uppsala, Uppsala, Sweden
- PathWest, Fiona Stanley Hospital, Perth, WA, Australia
- Etablissement Français du Sang Auvergne Rhône Alpes, site de Lyon, Décines, France
- Institute for Experimental Cellular Therapy, University of Duisburg-Essen, Essen, Germany
- Center for International Blood and Marrow Transplant Research, Milwaukee, WI
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
- Anthony Nolan Research Institute, Royal Free Hospital, London, United Kingdom
- Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
- Leiden University Medical Centre, Department Immunohematology and Blood Transfusion, Leiden, the Netherlands
- Matchis Foundation, Leiden, the Netherlands
- Center for International Blood and Marrow Transplant Research, Minneapolis, MN
- Geneva University Hospital, Geneva, Switzerland
- Basic Science Program, Frederick National Laboratory for Cancer Research, Frederick, MD
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge, MA
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14
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Fleischhauer K. Selection of matched unrelated donors moving forward: from HLA allele counting to functional matching. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:532-538. [PMID: 31808865 PMCID: PMC6913495 DOI: 10.1182/hematology.2019000057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Matched unrelated donors (URD) are the most frequent source of stem cells for allogeneic hematopoietic cell transplantation (HCT) to date, with HCT performed mainly under conventional immunosuppression by methotrexate and cyclosporine. In this setting, every single allelic donor-recipient mismatch for HLA-A, -B, -C, -DRB1 (8/8), but not for HLA-DQB1, -DPB1, has a significant negative effect on overall survival (OS). When several 8/8 HLA-matched URD are available, donor age is the most important factor impacting OS. Moving forward from the traditional way of counting the number of donor-recipient HLA allele mismatches to biology-driven algorithms for functional matching has led to the unraveling of an association between permissive, low-risk HLA-DPB1 mismatches and improved outcome after URD HCT for malignant disease but not for nonmalignant disease. Functional HLA matching might prove to have increasing importance for URD selection in the era of new immunosuppressive regimens that have the potential to substantially reshuffle the role of HLA mismatches in URD HCT.
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