Significance of one human leukocyte antigen mismatch on outcome of nonmyeloablative allogeneic stem cell transplantation from related donors using the Mexican schedule

Ruíz‐Argüelles, Guillermo J.; López-Martı́nez, Briceida; Manzano, Carlos; Gómez-Rangel, J. David; Lobato-Mendizábal, E

doi:10.1038/sj.bmt.1704780

Cited by 3 publications

(1 citation statement)

References 32 publications

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“…However, no account was taken of the actual mismatch in question because DNA‐based typing was not available. The clinical implications of five‐out‐of‐six HLA loci matching in terms of graft‐versus‐host‐disease (GVHD) and graft rejection are unclear (6) although a recent study of five‐out‐of‐six HLA loci mismatching in non‐myeloablative stem cell transplants indicated a trend to poorer median survival and increased GVHD and relapse rates when compared with 6/6 HLA‐loci‐matched transplants (7). Studies of New Zealand Maori population class II loci were carried out in the 1980s and in the early 1990s.…”

Section: Introductionmentioning

confidence: 99%

Class II HLA allele polymorphism: DRB1, DQB1 and DPB1 alleles and haplotypes in the New Zealand Maori population

Tracey

Carter

2006

Tissue Antigens

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Class II alleles of interest to transplantation comprise the DRB1, DQB1 and DPB1 loci. Sequence-based typing was used to determine the class II allelic variability present in New Zealand Maori, a population with close genetic ties to Polynesia and known anthropological and linguistic connections to mainland Asia. The most common DRB1 alleles identified were DRB1*1201, DRB1*110101, DRB1*0403 and DRB1*080302, with frequencies of 21.5%, 14%, 11.25% and 9.25%, respectively. Standard linkages between the DRB1 locus and the DRB3, 4 and 5 loci were maintained, with no novel patterns identified. The most common DQB1 alleles identified were DQB1*030101, DQB1*060101, DQB1*020101, DQB1*0602 and DQB1*050201, with frequencies of 29.5%, 8%, 7.8%, 6.4% and 6.2%, respectively. The most common DPB1 alleles identified were DPB1*0501, DPB1*040101 and DPB1*020102, with frequencies of 40.2%, 28.89% and 15.83%, respectively. A total of 80 estimated DRB1-DQB1 two-locus haplotypes were detected. DRB1*1201-DQB1*030101 was the most frequent (15.40%) haplotype, followed by DRB1*110101-DQB1*030101 (9.97%), DRB1*0403-DQB1*030201 (7.37%) and DRB1*080302-DQB1*060101 (5.96%). The allelic variation determined is being used in further analysis of the requirement for bone marrow transplantation in the New Zealand Maori population and has implications for optimal ethnic donor distribution on the New Zealand Bone Marrow Donor Registry, anthropological studies and disease association.

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Section: Introductionmentioning

confidence: 99%

Class II HLA allele polymorphism: DRB1, DQB1 and DPB1 alleles and haplotypes in the New Zealand Maori population

Tracey

Carter

2006

Tissue Antigens

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Long‐term follow‐up of peripheral blood stem cell transplantation from mismatched related and unrelated donors

Blau

Schmidt‐Hieber

Basara

et al. 2007

Clinical Transplantation

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Allogeneic stem cell transplantation (SCT) is best performed with an HLA-identical sibling donor (matched related donor, MRD) to reduce the risk of early complications such as acute graft-vs.-host disease (aGvHD). However, as only about 30% of recipients have an MRD for this potentially curative approach, the use of family donors with one or two mismatches in the HLA-antigens (mismatch related donor, MMRD) or fully matched unrelated donors (MUD) (''alternative donors'') has been introduced in the allogeneic SCT setting in recent years. To evaluate the feasibility of allogeneic SCT from alternative donors by using peripheral blood stem cells (PBSC) we initiated a prospective, phase II study in 1996. From April 1996 to July 1998, 18 patients with various hematological malignancies underwent allogeneic SCT from alternative donors (two patients with MUD and 16 patients with MMRD). All patients received stable engraftment and none of the patients had graft rejection. The rate of aGvHD (grades II-IV) and the relapse rate at last follow-up (seven to nine yr after SCT) were with 40% and 24%, respectively, comparable with those found in patients receiving allogeneic SCT from MRD. However, five yr after allogeneic SCT only 17% were alive, which was mainly due to the treatment-related mortality (TRM) rate of 59%. We conclude that allogeneic PBSC transplantation by using alternative donors is associated with an unsatisfying long-term TRM rate. The significance of TRM and particular late deaths has to be evaluated further in this transplantation setting.

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Making Allogeneic Bone Marrow Transplantation Available to Patients in Developing Countries: The Mexican Experience

Ruíz‐Argüelles¹,

Gómez‐Almaguer²

2008

TOHJ

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Non-myeloablative allogeneic stem cell transplantation (NST) has been one of the most exciting developments in the treatment of hematologic malignancies in the last years. Since 1999, we have chosen to employ in México a regimen to conduct NST, introducing some changes with the main goal of decreasing the cost of the procedure and in turn, making it available to a larger number of patients in developing countries. Using this method we have done over 400 allografts in Latin American patients with different both malignant and non-malignant diseases: Chronic myelogenous leukemia, acute myelogenous leukemia, acute lymphoblastic leukemia, myelodysplasia, thalassemia major, relapsed Hodgkin´s disease, Blackfan-Diamond syndrome, adrenoleukodystrophy, Hunter´s syndrome, aplastic anemia and several solid tumors. In the whole group, the median granulocyte recovery time to 0.5 x 10 9 /L was 13 days, whereas the median platelet recovery time to 20 x 10 9 /L was 12 days. Around one third of the patients did not need red blood cell transfusions and also one third did not need platelet transfusions. In more than 70% of cases the procedure could be completed totally on an outpatient basis. The follow up time of the patients ranges between 30 and 2000 days. Approximately 50% of the allografted individuals have developed acute graft versus host disease (GVHD), whereas around 30% developed chronic GVHD. The median post-allograft overall survival (SV) has not been reached and the 2000 day overall SV is 54%, the 100-day mortality being 16%. In the whole group of patients, the median cost of each NST was 18 000 USD, a figure which contrasts with that informed from developing countries. More than 95% of the patients who were allografted in México and Latin America using this method could not have afforded the cost of a conventional or more expensive stem cell transplant; accordingly, this procedure has enabled doctors in México and Latin America to offer this therapeutic approach to a larger number of individuals.

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Significance of one human leukocyte antigen mismatch on outcome of nonmyeloablative allogeneic stem cell transplantation from related donors using the Mexican schedule

Cited by 3 publications

References 32 publications

Class II HLA allele polymorphism: DRB1, DQB1 and DPB1 alleles and haplotypes in the New Zealand Maori population

Class II HLA allele polymorphism: DRB1, DQB1 and DPB1 alleles and haplotypes in the New Zealand Maori population

Long‐term follow‐up of peripheral blood stem cell transplantation from mismatched related and unrelated donors

Making Allogeneic Bone Marrow Transplantation Available to Patients in Developing Countries: The Mexican Experience

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