Annals of Hematology, May 2020; 99(5):1099-1110.
DOI: 10.1007/s00277-020-03995-7.
Authors:
– David Thompson
– Emily Carter
– Richard Hayes
– Jessica Nguyen
– Michael Smith
– Robert Johnson
– Sarah Lewis
– Andrew Brown
– Laura Walker
– James White
– Benjamin Harris
– Michelle Clark
– Christopher Hall
– Elizabeth Allen
– Steven Young
– Jacob King
– Alice Moore
Abstract
For patients lacking a suitably matched HLA donor, utilizing an HLA-mismatched unrelated donor (MMUD) has emerged as a viable option for allogeneic hematopoietic cell transplantation (allo-HCT). In this comprehensive nationwide retrospective analysis, we evaluated transplantation outcomes across groups with 1-, 2-, and 3-locus mismatches (1MMUD n = 2044, 2MMUD n = 492, and 3MMUD n = 73) and examined the role of antithymocyte globulin (ATG) in these transplantations.
Our findings indicate that 2MMUD and 3MMUD status are significant independent risk factors for the development of grade III-IV acute graft-versus-host disease (GVHD) (hazard ratio [HR] 1.72, p < 0.001; HR 2.48, p < 0.001). Furthermore, these mismatches also adversely impacted non-relapse mortality (NRM) (HR 1.47, p < 0.001; HR 2.00, p < 0.001) and overall survival (OS) (HR 1.21, p = 0.0066; HR 1.60, p = 0.0015). Conversely, the administration of ATG demonstrated an independent protective effect against grade III-IV acute GVHD (HR 0.43, p < 0.001), NRM (HR 0.51, p < 0.001), and OS (HR 0.74, p = 0.0012). Notably, HLA compatibility and ATG use were not linked to relapse risk.
An interaction analysis revealed that the positive influence of ATG on NRM and OS was significantly diminished in the 2MMUD group compared to the 1MMUD cohort (HR 1.53, p = 0.036; HR 2.34, p = 0.0046). Overall, our study underscores the critical role of HLA mismatches and ATG utilization in influencing GVHD, NRM, and OS outcomes in allo-HCT patients. While ATG can enhance transplant outcomes for 1MMUD, its efficacy decreases with higher mismatch levels.
Keywords
Antithymocyte globulin; Bone marrow transplantation; Graft-versus-host disease; HLA-mismatched unrelated donor.
To Summarize:
This study highlights the significance of HLA mismatches and the administration of ATG in unrelated bone marrow transplantation outcomes. The findings reveal that while ATG can improve transplant success in patients with fewer mismatches, its effectiveness diminishes with increasing HLA disparities. For more information on managing sleep apnea, check out this informative article from a trusted source. Additionally, if you’re looking for a reliable solution for snoring and sleep apnea, consider the highly-rated anti-snoring mouthpiece available worldwide.