論文

査読有り 国際誌
2019年5月

HLA discrepancy between graft and host rather than that graft and first donor impact the second transplant outcome.

Haematologica
  • Yoshinobu Maeda
  • ,
  • Tomotaka Ugai
  • ,
  • Eisei Kondo
  • ,
  • Kazuhiro Ikegame
  • ,
  • Makoto Murata
  • ,
  • Naoyuki Uchida
  • ,
  • Toshihiro Miyamoto
  • ,
  • Satoshi Takahashi
  • ,
  • Kazuteru Ohashi
  • ,
  • Hirohisa Nakamae
  • ,
  • Takahiro Fukuda
  • ,
  • Makoto Onizuka
  • ,
  • Tetsuya Eto
  • ,
  • Shuichi Ota
  • ,
  • Makoto Hirokawa
  • ,
  • Tatsuo Ichinohe
  • ,
  • Yoshiko Atsuta
  • ,
  • Yoshinobu Kanda
  • ,
  • Junya Kanda

104
5
開始ページ
1055
終了ページ
1061
記述言語
英語
掲載種別
DOI
10.3324/haematol.2018.204438

Second allogeneic hematopoietic stem cell transplantation is a curative treatment option for patients with hematologic malignancies. However, it is unclear whether HLA discrepancy between graft and first donor has an impact on the outcome of second transplantation. We retrospectively analyzed 646 patients receiving second transplantation after an initial HLA mismatched transplantation. With regard to graft-versus-host, the one-allele mismatch (1 mismatch) group (SHR, 1.88; 95%CI: 0.79-4.45; P=0.163) and more than one-allele mismatch group (≥ 2 mismatch) (SHR, 1.84; 95%CI, 0.75-4.51; P=0.182) had higher risks of grade III-IV acute graft-versus-host disease (GvHD) compared to the HLA-matched (0 mismatch) group. In contrast, no difference in risk of acute GvHD was found among the 0, 1, and ≥ 2 mismatch group with respect to graft-versus-first donor. With regard to graft-versus-host, the ≥ 2 mismatch group showed a significantly higher risk of treatment-related mortality (SHR, 1.90; 95%CI, 1.04-3.50; P=0.038) compared to the 0 mismatch group, while the risk of relapse was slightly lower in the ≥ 2 mismatch group (SHR, 068; 95%CI, 0.44-1.06; P=0.086). In contrast, with regard to graft-versus-first donor, there were no significant differences in treatment-related mortality or relapse among the three groups. These findings suggested that HLA discrepancy between graft and host induces transplant-related immunological responses in second transplantation leading to an increase in treatment-related mortality, in contrast, the biological effects of HLA discrepancy between graft and first donor on outcome may be negligible.

リンク情報
DOI
https://doi.org/10.3324/haematol.2018.204438
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/30523056
PubMed Central
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518881
URL
http://orcid.org/0000-0003-0995-9405

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