10/10 compatibility in hematopoietic stem cell transplantations (HSCT) may improve outcomes as compared to 9/10: a single-center study
Natalia V. Sidorova1, Kirill I. Kirgizov1, Dmitry N. Balashov2, Pavel E. Trachtman2, Marina Y. Persiantseva2, Ekaterina A. Pristanskova1, Veronika V. Konstantinova1, Oxana L. Blagonravova1, Michael A. Maschan2, Elena V. Skorobogatova1, Alexey A. Maschan2
1 The Russian Clinical Children’s Hospital, Moscow
2 Dmitry Rogachev Federal Research Center of Pediatric Hematology, Oncology and Immunology, Moscow
HSCT from matched unrelated donors (MUD) is routine therapy approach in wide variety of disorders. However, current probability of finding a fully HLA-matched donor is only 70-75%. Hence, the aim of our study was to evaluate HSCT results in children from the fully matched (10/10) versus 9/10 compatible donors using retrospective data.
Patients and methods
159 HSCT from 9/10- and 10/10-compatible MUD were performed over the period of 2003-2014. The patients were diagnosed with AML, 43% (n=68); ALL, 19% (n=31); aplastic anemia, 12% (n=24); inherited metabolic disorders, 10% (n=16); PID syndromes, 4% (n=6), and others, 8% (n=14). Male-to-female ratio was 107:52 (2:1), median of age was 7,6 (1-17 years old). Stem cell sources were as follows: bone marrow, 77% (n=122), peripheral blood stem cells, 23% (n=37). 126 patients (79%) received 10/10 MUD HSCT, and 33 patients (21%) underwent 9/10 MUD HSCT. Conditioning regimens contained different agents, depending on the therapeutic protocol and type of disease.
Overall incidence of aGvHD (grade I-IV) in the 10/10 group was 83% (n=107), and 82% (n=27), in the 9/10 group. Frequency of severe aGvHD (grade III-IV) was, respectively, 17,5% (n=22), and 21% (n=7). We have revealed that the mode of GvHD prevention can significantly improve outcome, e. g., Tacrolimus/MTX prevention proved to be favorable, in comparison with other prophylaxis modes (Tacro/MMF etc.). The Tacrolimus/MTX schedule was associated with decreased probability of aGvHD in the both HSCT groups: in cases with 10/10 matches, from 16% to 1,5%; for 9/10 group – from 18% to 3%. Infectious episodes did not significantly differ between the 9/10 and 10/10 groups. Upon a long-term follow-up (a median of 11 years), an estimated probability of overall survival was 60.2% in the 10/10 group, as compared to 41,8% for the 9/10 group.
Our results suggest that 10/10-matched transplants are associated with better outcome and lower incidence of severe aGvHD. In our experience, the results of 9/10-matched HSCTs tend to improve over past several years. Hence, the 9/10-matched transplants present a good option, if a 10/10-matched donor is not available.
Host-versus-gra disease, unrelated donors, partial hla matching, prophylaxis, аllogeneic hematopoietic stem cell transplantation, children neurometabolic diseases