Abstract
We retrospectively reviewed transplant outcomes of 32 patients who received an allogeneic stem cell transplant from single human leukocyte antigen (HLA) mismatched related family donors (MMRD), and compared them to 45 case-matched controls who received transplants from matched unrelated donors (MUD). Controls were matched for age, sex, disease type, disease status, CMV seropositivity, and type of conditioning regimen (full versus reduced intensity). Full donor neutrophil engraftment for MMRD and MUD transplants were achieved in 81% and 93% of patients respectively (p=0.1). Grade 2–4 acute graft-versus-host disease (GVHD) developed in 32% of MMRD transplants versus 42% for MUD transplants (p=0.43). Limited and extensive chronic GVHD developed in 22% and 19% of MMRD transplants versus 14% and 30% of MUD transplants (p=0.61). Day 100 transplant related mortality (TRM) for MMRD and MUD transplants were 31% and 33% respectively (p=0.69). Disease relapse occurred in 16% of MMRD transplants versus 13% in MUD transplants (p=0.87). Overall survival at 1 and 3 years for MMRD transplants were 53% and 40% versus 49% and 32% for MUD transplants (p=0.61). There were no statistically significant differences among HLA-A, HLA-B, and HLA-DR MMRD transplants in terms of neutrophil engraftment and grade 2–4 acute GVHD, but day 100 TRM among HLA-DR MMRD transplants were higher than among HLA-A and HLA-B MMRD transplants (50% versus 0% and 17% respectively, p=0.01). Overall survival at 3 years was 53% for HLA-A and HLA-B MMRD transplants, 30% for HLA-DR MMRD transplants, and 32% for MUD transplants (p=0.42). In conclusion, single antigen mismatched related donor allogeneic stem cell transplants have similar transplant outcomes as matched unrelated donor allogeneic stem cell transplants and usually takes a shorter amount of time to stem cell donation. HLA-DR mismatch transplants have higher day 100 TRM than Class I mismatch transplants. Single antigen mismatched related donors should be considered as donors for allogeneic stem cell transplantation.
MMRD vs MUD Transplants
| MMRD | MUD | P-value | |
|---|---|---|---|
| MMRD=mismatch related donor; MUD=matched unrelated donor | |||
| N | n=32 | n=45 | |
| Median age | 44 years | 41 years | P=0.14 |
| High-Risk Disease | 63% | 71% | P=0.51 |
| CMV Seropositivity | 45% | 42% | P=0.93 |
| Full Conditioning | 72% | 76% | P=0.72 |
| Neutrophil Engraftment | 81% | 93% | P=0.1 |
| Grade 2–4 aGVHD | 32% | 42% | P=0.43 |
| Day 100 TRM | 31% | 33% | P=0.69 |
| Disease Relapse | 16% | 13% | P=0.87 |
| 3-year OS | 40% | 32% | P=0.6 |
| MMRD | MUD | P-value | |
|---|---|---|---|
| MMRD=mismatch related donor; MUD=matched unrelated donor | |||
| N | n=32 | n=45 | |
| Median age | 44 years | 41 years | P=0.14 |
| High-Risk Disease | 63% | 71% | P=0.51 |
| CMV Seropositivity | 45% | 42% | P=0.93 |
| Full Conditioning | 72% | 76% | P=0.72 |
| Neutrophil Engraftment | 81% | 93% | P=0.1 |
| Grade 2–4 aGVHD | 32% | 42% | P=0.43 |
| Day 100 TRM | 31% | 33% | P=0.69 |
| Disease Relapse | 16% | 13% | P=0.87 |
| 3-year OS | 40% | 32% | P=0.6 |
Figure
