A significant segment of hematopoietic stem cell transplantations are performed with ABO-mismatched donors. The impact of ABO-mismatch on outcome following transplantation remains controversial and there is no published data regarding the impact of ABO-mismatch in acute myeloid leukemia patients receiving haploidentical transplantation. Using the EBMT acute leukemia working group registry we identified 837 patients who underwent haploidentical transplantation. Comparative analysis was performed between patients receiving ABO-matched versus ABO-mismatched for common clinical outcome variables. Our cohort consisted of 522 ABO-matched pts and 315 ABO-mismatched patients including 150 minor, 127 major, and 38 bidirectional ABO mismatched. There were no significant differences between ABO matched and mismatched patients in terms of baseline disease and clinical characteristics. Major ABO mismatching was associated with inferior day 100 engraftment rate whereas multivariate analysis showed bi-directional mismatching to be associated with increased risk for grade II-IV acute graft versus host disease (hazard ratio [HR] of 2.387, 95% confidence interval [CI], 1.22-4.66; p=0.01). Non-relapse mortality, relapse incidence, leukemia free survival, overall survival, and chronic graft versus host disease rates were comparable between ABO matched and mismatched patients. Focused analysis for stem cell source showed that patients with minor mismatching transplanted with bone marrow grafts experienced increased grade II-IV acute graft versus host disease rates (HR of 2.03, 95% CI, 1.00-4.10; p=0.04). Patients with major ABO mismatching and bone marrow grafts had decreased survival (HR=1.82, CI 95%, 1.048-3.18; p=0.033). In conclusion, ABO incompatibility has a marginal but significant clinical effect in acute myeloid leukemia patients undergoing haploidentical transplantation.
Canaani, J., Savani, B., Labopin, M., Huang, X., Ciceri, F., Arcese, W., et al. (2017). Impact of ABO incompatibility on patient outcome in haploidentical hematopoietic stem cell transplantation for acute myeloid leukemia - a report from the acute leukemia working party of the EBMT. HAEMATOLOGICA, 102(6), 1066-1074 [10.3324/haematol.2016.160804].
Impact of ABO incompatibility on patient outcome in haploidentical hematopoietic stem cell transplantation for acute myeloid leukemia - a report from the acute leukemia working party of the EBMT
ARCESE, WILLIAM;
2017-01-01
Abstract
A significant segment of hematopoietic stem cell transplantations are performed with ABO-mismatched donors. The impact of ABO-mismatch on outcome following transplantation remains controversial and there is no published data regarding the impact of ABO-mismatch in acute myeloid leukemia patients receiving haploidentical transplantation. Using the EBMT acute leukemia working group registry we identified 837 patients who underwent haploidentical transplantation. Comparative analysis was performed between patients receiving ABO-matched versus ABO-mismatched for common clinical outcome variables. Our cohort consisted of 522 ABO-matched pts and 315 ABO-mismatched patients including 150 minor, 127 major, and 38 bidirectional ABO mismatched. There were no significant differences between ABO matched and mismatched patients in terms of baseline disease and clinical characteristics. Major ABO mismatching was associated with inferior day 100 engraftment rate whereas multivariate analysis showed bi-directional mismatching to be associated with increased risk for grade II-IV acute graft versus host disease (hazard ratio [HR] of 2.387, 95% confidence interval [CI], 1.22-4.66; p=0.01). Non-relapse mortality, relapse incidence, leukemia free survival, overall survival, and chronic graft versus host disease rates were comparable between ABO matched and mismatched patients. Focused analysis for stem cell source showed that patients with minor mismatching transplanted with bone marrow grafts experienced increased grade II-IV acute graft versus host disease rates (HR of 2.03, 95% CI, 1.00-4.10; p=0.04). Patients with major ABO mismatching and bone marrow grafts had decreased survival (HR=1.82, CI 95%, 1.048-3.18; p=0.033). In conclusion, ABO incompatibility has a marginal but significant clinical effect in acute myeloid leukemia patients undergoing haploidentical transplantation.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
