National marrow donor program HLA-matching guidelines for unrelated marrow transplants

Hurley, Carolyn Katovich; Lowe, Lee Ann Baxter; Logan, Brent R.; Karanes, Chatchada; Anasetti, Claudio; Weisdorf, DJ; Confer, Dennis L.

doi:10.1016/j.bbmt.2003.08.009

Cited by 81 publications

(45 citation statements)

References 13 publications

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“…29 A total of 49 patients underwent treatment with G-CSF followed by apheresis that started on the fifth day as described. 30 Apheresis was performed on 1 additional day with the goal of obtaining 5 Â 10 6 CD34 þ cells per kg recipient body weight.…”

Section: Patients Donors and Methodsmentioning

confidence: 99%

Long-term disease-free survival after nonmyeloablative cyclophosphamide/fludarabine conditioning and related/unrelated allotransplantation for acute myeloid leukemia/myelodysplasia

Nelson

Schwartz

et al. 2010

Bone Marrow Transplant

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A total of 50 consecutive patients (median age, 57.5 years) with AML (n ¼ 30) or myelodysplasia (MDS, n ¼ 20) underwent HLA matched related donor (MRD, n ¼ 27) or unrelated donor (MUD, n ¼ 23) peripheral blood hematopoietic cell transplantation after nonmyeloablative CY/fludarabine (Flu) conditioning. GVHD prophylaxis included CsA (n ¼ 19) ± mycophenolate mofetil (n ¼ 31). At a median follow-up of 59 months, 21 patients (42%) were alive without evidence of disease. By Kaplan-Meier analysis, year 1-4 disease-free survival (DFS) and OS estimates were 0.50/0.58, 0.40/0.46, 0.37/0.43 and 0.37/0.41. MUD recipients were engrafted quickly (13.5 days) compared to MRD recipients (16 days) and relapsed/progressed less frequently (P ¼ 0.005). Overall grade 3/4 acute GVHD (aGVHD) occurred in 26% in the absence of antecedent mucositis and was associated with chronic GVHD (cGVHD) and poor OS. Extensive cGVHD developed in 51.2% of 100 day survivors. Rates of aGVHD, cGVHD and survival were similar between MRD and MUD recipients. Of 14 survivors with cGVHD, 5 (35.7%) experienced resolution off immunosuppression, suggesting that tolerance with HLA matched grafts is possible at an advanced age by this method. This study provides further evidence for prolonged DFS after CY/Flu MRD allotransplantation for AML/MDS, and extends the findings to older patients and those with unrelated donors.

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Section: Patients Donors and Methodsmentioning

confidence: 99%

Long-term disease-free survival after nonmyeloablative cyclophosphamide/fludarabine conditioning and related/unrelated allotransplantation for acute myeloid leukemia/myelodysplasia

Nelson

Schwartz

et al. 2010

Bone Marrow Transplant

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“…Current search algorithm recommends matching at least seven of eight high resolution at HLA-A, HLA-B, HLA-C and HLA-DRB1 loci. 26 Recent data support that allelic (high resolution) mismatches are as significant as broad antigen mismatches. A recent National Marrow Donor Program review of 3857 US transplantations performed from 1988 to 2003 with patient-donor pairs fully typed for HLA-A, B, C, DRB1, DQB1, DQA1, DPB1 and DPA1 alleles demonstrated that high-resolution DNA matching for HLA-A, B, C and DRB1 (8/8 match) was the minimum level of matching associated with the highest survival.…”

Section: Selection Of Unrelated Adult Donor Hsc For Transplantation: mentioning

confidence: 98%

Selection of cord blood unit(s) for transplantation

Wall

Chan

2008

Bone Marrow Transplant

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Selection of cord blood (CB) units for transplantation involves combining both cell dose and HLA matching as independent yet overlapping variables. Cell dose and cell yield at the time of transplant are critical given that the transplants are being performed with minimal cells for reliable engraftment. In transplants for malignant disorders, the greater allogenicity and lower relapse rate associated with the less well-matched units balance any benefit of better HLA matching on TRM. The only factor that has repeatedly been associated with improved outcome post CB transplant is cell dose. The CB inventories are rapidly increasing in size and the quality of CB units being banked (larger, better characterized) is improving. With this, some of our current limitations in CB availability will soon become moot. Explorations into CB expansion and multiple CB unit transplants are addressing the limited cell doses attainable with a single CB collection. [1][2][3][4] At this point, one must conclude that bigger is better when selecting CB units for transplantation.

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“…All related (n ¼ 26, 53.1%) or unrelated (n ¼ 23, 46.9%) donors were fully matched at HLA-A, HLA-B and HLA-DR loci (molecular or serological class I typing and molocular typing of Class II). 26 All patients were followed until death or at least 7 months (range, 25-1675 days; median, 413 days).…”

Section: Nonmyeloablative Protocolmentioning

confidence: 99%