Improved survival in matched unrelated donor transplant for childhood ALL since the introduction of high-resolution matching at HLA class I and II

Abstract

We present the first detailed study analysing OS in BMT for paediatric ALL following the introduction of high-resolution (HR) HLA matching. A total of 356 consecutive paediatric ALL stem cell transplants performed between 1988 and 2007 were reviewed; 80 of them were performed following the introduction of HR HLA class I and class II matching to the transplant programme in 2002. Comparisons of matched unrelated donor (MUD) transplant outcomes before and after this period were made. Matching at the HR level for HLA-A, -B, -C, -DRB1 and -DQB1 (HR-MUD) correlated with a greater than 25% improvement in 2-and 5-year OS in paediatric ALL patients transplanted with MUDs (P ¼ 0.009, P ¼ 0.005, respectively). Two-year OS for contemporaneous HLA-matched sibling transplants (80.8%) and HR-MUD transplants (78.8%) was equivalent. At 6%, non-relapse mortality (NRM) in MUD transplants since 2002 was significantly reduced compared with previous epochs. Changes in treatment and epoch-dependent improvements in outcome were reviewed for possible confounders to the influence of HR typing using univariate and multivariate analysis.

Correlation between microsatellite discrepancy scores and transplant outcome after haemopoietic SCT for pediatric ALL

“…14 In that study the high-resolution HLA-matched patient cohort did not differ significantly from the other patients for the above listed covariates. Only D/R relationship, high-resolution HLA match grade and disease status at the time of transplantation were shown statistically to significantly affect transplant outcome.…”

Beating the odds: factors implicated in the speed and availability of unrelated haematopoietic cell donor provision

“…By reducing the incidence of hidden mismatches, transplant outcomes are improved. 9,50 More established registries might have thousands of donors recruited and typed many years or decades ago, when only serological techniques were available. Out of financial or technological necessity many donor registries perform limited typing of their new donors, either through use of low-resolution typing, through typing at just two HLA loci (for example, HLA-A and -B), or both.…”

Transplant Outcomes for Children with T Cell Acute Lymphoblastic Leukemia in Second Remission: A Report from the Center for International Blood and Marrow Transplant Research

“…14–16 Past analyses included older treatment eras (1980s and 1990s) with little data on current HCT outcomes for children with relapsed T-ALL receiving contemporary treatment strategies. Whether improvements in the current HCT era (post-2000) have resulted in improved survival, particularly with enhanced high-resolution HLA-typing 17 and better supportive care 18 , is unclear. Likewise, whether patient-, disease-, or HCT-related variables impact outcomes in relapsed T-ALL in children is uncertain.…”