Recipient/donor HLA and CMV matching in recipients of T-cell-depleted unrelated donor haematopoietic cell transplants

Shaw, Bronwen E.; Mayor, Neema P.; Szydlo, Richard; Bultitude, Will P.; Anthias, Chloe; Kirkland, Keiren; Perry, Julia; Clark, Andrew; Mackinnon, Stephen; Marks, David I.; Pagliuca, Antonio; Potter, Mike; Russell, Nigel H.; Thomson, Kirsty; Madrigal, J. Alejandro; Marsh, Steven G.E.

doi:10.1038/bmt.2016.352

Cited by 56 publications

(51 citation statements)

References 37 publications

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“…The impact of multiple donor factors including CMV on survival was investigated in a multicentre study of 1271 UK patients transplanted with an unrelated donor for malignant disease (Shaw et al ., ). Patients who were CMV seropositive at the time of transplant had a reduced median survival (1.7 years) compared with CMV seronegative patients (2.5 years, P = 0.013).…”

Section: Non‐hla Factors To Be Considered For Related and Unrelated Dmentioning

confidence: 97%

BSHI Guideline: HLA matching and donor selection for haematopoietic progenitor cell transplantation

Little

Green

Harvey

et al. 2016

Int J Immunogenetics

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List of recommendations• All laboratories performing H&I testing for allogeneic HPC transplantation should follow EFI standards and be accreditated by EFI and UKAS/CPA. (Grade 1A)• HLA typing definitions as described by Nunes et al. 2011 and here should be used (Grade 1A)• HLA typing results should use official WHO HLA Nomenclature (Grade 1A)• The clinical urgency should be made available to the individual performing the related and unrelated donor search (Grade 1B)• HLA high resolution typing should be performed on potential matching; mismatching and haploidentical related donors when familial haplotypes cannot be fully assigned (Grade 1A)• Patients and selected related donors should be typed for HLA-A, -B, -C, -DRB1 and -DQB1 (+/-DPB1) (Grade 1A).• All patients and donors must have their HLA type confirmed on a second sample pre-transplant (Grade 1A).• The patient should be high resolution typed prior to submitting the HLA type for an unrelated donor search (Grade 1A)• A 10/10 high resolution HLA-A, -B, -C, -DRB1 and -DQB1 matched unrelated PBSC or bone marrow donor should be used where possible (Grade 1A).• Where a 10/10 matched PBSC or bone marrow donor is not available a single mismatch at HLA-A, -B, -C, -DRB1 or -DQB1 is acceptable (Grade 1A).• Alternative progenitor cell donors (cord blood or haplo-identical) should be considered early in the donor search when a patient is unlikely to have an HLA matched unrelated donor (Grade 1A).• HLA-DRB3, -DRB4, -DRB5 typing should be performed and, when a choice of otherwise equally matched and appropriate (e.g. CMV status) donors is available, mismatches for these should be minimized (Grade 2A). • For unrelated donor selection, HLA-DPB1 typing should be performed and when a choice of otherwise equally matched and appropriate (e.g. CMV status) donors is available, non-permissive mismatches should be minimised (Grade 2C).• For mismatched related and unrelated donor selection, HVG mismatches are favoured over bi-directional and GVH mismatches (Grade 2C).• UCB units should be HLA typed to high resolution HLA-A, -B, -C, -DRB1, -DQB1 (Grade 1B ).• Selection of UCB units should follow national consensus guidelines published by Hough et al. (Grade 1A).• HLA alloantibody testing of the recipient should be performed at the time of donor search and should be repeated at the time of donor work-up request if an HLA mismatched donor is selected (Grade 1A).• The clinical team must be made aware of any HLA alloantibody incompatibility for a selected donor (Grade 1A).• When a choice of equally well matched donors is available, avoid selection of donors against which the patient has HLA alloantibodies (Grade 1A).• HLA alloantibody testing should be performed in cases of failed engraftment if the donor is HLA mismatched (Grade 1B).• The guideline published by Emery et al., 2013 recommending CMV matching between patient and donor should be followed (Grade 1A).• Major ABO incompatibilities should be avoided when there is a choice of HLA and CMV matched donors (Grade 1A)• Male donors ...

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Section: Non‐hla Factors To Be Considered For Related and Unrelated Dmentioning

confidence: 97%

BSHI Guideline: HLA matching and donor selection for haematopoietic progenitor cell transplantation

Little

Green

Harvey

et al. 2016

Int J Immunogenetics

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“…False positive results may lead to a CMV‐seropositive donor being sought with potential for CMV transmission to a CMV naïve recipient and significant risk of post‐transplant CMV infection. Matching of donor/recipient serostatus is an important predictor of outcome following SCT (Boeckh & Nichols, ; Schmidt‐Hieber et al , ; Shaw et al , ).…”

Section: Introductionmentioning

confidence: 99%

Transfusion of CMV‐unselected blood components may lead to inappropriate donor selection for patients subsequently undergoing allogeneic stem cell transplant

Morton

Danby

Rocha

et al. 2015

Transfusion Medicine

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Passive transfer of CMV IgG is an unanticipated consequence of transfusion of CMV-U products and has the potential to cause morbidity. Inaccurate recording of serostatus pre-transplant has wider implications for data reporting on transplant outcomes. When transfusing CMV-U components pre-transfusion CMV IgG samples must be taken and transfusion history must be considered when interpreting results.

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“…Disease status (homozygosity or heterozygosity) for sibling donors affected by inherited BM failure, immune deficiency and metabolic disorders should be taken into account in donor selection. For cytomegalovirus seropositive patients with malignancy, an unrelated donor UCBT may be preferable to a mismatched cytomegalovirus‐negative unrelated volunteer donor (Shaw et al , ).…”

Section: Donor Selection Algorithmsmentioning

confidence: 99%

Recommendations for a standard UK approach to incorporating umbilical cord blood into clinical transplantation practice: an update on cord blood unit selection, donor selection algorithms and conditioning protocols

Hough

Danby

Russell³

et al. 2015

Br J Haematol

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SummaryAllogeneic haemopoietic stem cell transplantation offers a potentially curative treatment option for a wide range of lifethreatening malignant and non-malignant disorders of the bone marrow and immune system in patients of all ages. With rapidly emerging advances in the use of alternative donors, such as mismatched unrelated, cord blood and haploidentical donors, it is now possible to find a potential donor for almost all patients in whom an allograft is indicated. Therefore, for any specific patient, the transplant physician may be faced with a myriad of potential choices, including decisions concerning which donor to prioritize where there is more than one, the optimal selection of specific umbilical cord blood units and which conditioning and graft-versus-host disease prophylactic schedule to use. Donor choice may be further complicated by other important factors, such as urgency of transplant, the presence of alloantibodies, the disease status (homozygosity or heterozygosity) of sibling donors affected by inherited disorders and the cytomegalovirus serostatus of patient and donor. We report UK consensus guidelines on the selection of umbilical cord blood units, the hierarchy of donor selection and the preferred conditioning regimens for umbilical cord blood transplantation, with a summary of rationale supporting these recommendations.Keywords: stem cell transplantation, haematological malignancies, paediatric haematology, umbilical cord blood.Umbilical cord blood (UCB) is an established alternative source of haematopoietic stem cells (HSC) for allogeneic transplantation when suitable human leucocyte antigen (HLA)-matched sibling or well matched unrelated donors are unavailable. Over 35 000 UCB transplants have now been performed worldwide and there are over 630 000 cord blood units (CBU) currently stored in international cord blood blanks. The emerging experience of umbilical cord blood transplantation (UCBT) and, more recently, haploidentical donor transplants have extended access to HSC transplantation (HSCT) in almost all those previously precluded. Consequently, the optimal selection of a donor or specific CBU for an individual patient has become increasingly complex.Here we report new UK consensus recommendations for the method of selection of individual UCB units, the role of cord blood transplantation (CBT) within an overall donor selection strategy and the choice of conditioning regimens for CBT. These recommendations are primarily based on retrospective comparative studies and expert opinion given the lack of randomized trials comparing different donor choices. Cord blood transplantation in the UKThe inclusion of UCBT into routine practice in the UK was initially slow, despite the early establishment of the London Cord Blood Bank in 1996. The reasons for this included lack of a national strategy, lack of clinical trials, concern regarding the safety of UCBT in adults prior to 2004 and well Correspondence: BCSH secretary, British

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Recipient/donor HLA and CMV matching in recipients of T-cell-depleted unrelated donor haematopoietic cell transplants

Cited by 56 publications

References 37 publications

BSHI Guideline: HLA matching and donor selection for haematopoietic progenitor cell transplantation

BSHI Guideline: HLA matching and donor selection for haematopoietic progenitor cell transplantation

Transfusion of CMV‐unselected blood components may lead to inappropriate donor selection for patients subsequently undergoing allogeneic stem cell transplant

Recommendations for a standard UK approach to incorporating umbilical cord blood into clinical transplantation practice: an update on cord blood unit selection, donor selection algorithms and conditioning protocols

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